Provider Demographics
NPI:1659382091
Name:VENKATESH, SREEDEVI (AUD)
Entity Type:Individual
Prefix:DR
First Name:SREEDEVI
Middle Name:
Last Name:VENKATESH
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4122 HALEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615
Mailing Address - Country:US
Mailing Address - Phone:309-589-0119
Mailing Address - Fax:
Practice Address - Street 1:411 MARTIN LUTHER KING JR DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61605-2414
Practice Address - Country:US
Practice Address - Phone:309-497-0790
Practice Address - Fax:309-497-1343
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist