Provider Demographics
NPI:1629767298
Name:ESPINOZA, IRIS MIRIAM
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:MIRIAM
Last Name:ESPINOZA
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 1:896 FOTIS DR APT 8
Mailing Address - Street 2:
Mailing Address - City:DEKALB
Mailing Address - State:IL
Mailing Address - Zip Code:60115-6577
Mailing Address - Country:US
Mailing Address - Phone:815-503-1323
Mailing Address - Fax:
Practice Address - Street 1:58 W PARK AVE
Practice Address - Street 2:
Practice Address - City:SUGAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:60554-2208
Practice Address - Country:US
Practice Address - Phone:331-227-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist