Provider Demographics
NPI:1578221461
Name:ELAHI, SAMIA TASNIM
Entity Type:Individual
Prefix:
First Name:SAMIA
Middle Name:TASNIM
Last Name:ELAHI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 PEARSON ST APT 709
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60016-9219
Mailing Address - Country:US
Mailing Address - Phone:773-391-9648
Mailing Address - Fax:
Practice Address - Street 1:3400 S INDIANA AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60616-3841
Practice Address - Country:US
Practice Address - Phone:773-391-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-07
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
235Z00000X
IL242-006645235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist