Provider Demographics
NPI:1891468872
Name:MENDIOLA, VANESSA JADE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:JADE
Last Name:MENDIOLA
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 1:2227 S 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH RIVERSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60546-1216
Mailing Address - Country:US
Mailing Address - Phone:708-979-2349
Mailing Address - Fax:
Practice Address - Street 1:2227 S 5TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH RIVERSIDE
Practice Address - State:IL
Practice Address - Zip Code:60546-1216
Practice Address - Country:US
Practice Address - Phone:708-979-2349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-27
Last Update Date:2023-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist