Provider Demographics
NPI:1659597813
Name:DEL VALLE -MORALES, MILDRED (MA, SLP, CCC, L)
Entity Type:Individual
Prefix:MRS
First Name:MILDRED
Middle Name:
Last Name:DEL VALLE -MORALES
Suffix:
Gender:F
Credentials:MA, SLP, CCC, L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10329 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-4650
Mailing Address - Country:US
Mailing Address - Phone:708-952-0096
Mailing Address - Fax:708-952-0096
Practice Address - Street 1:10329 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-4650
Practice Address - Country:US
Practice Address - Phone:708-952-0096
Practice Address - Fax:708-952-0096
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146-006457235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist