Provider Demographics
NPI:1013488568
Name:FERNANDEZ, JOANNA (MS CCC)
Entity Type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:F
Credentials:MS CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1032 S ALDINE AVE
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-4471
Mailing Address - Country:US
Mailing Address - Phone:312-375-7377
Mailing Address - Fax:
Practice Address - Street 1:8200 W GREENDALE AVE
Practice Address - Street 2:
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-2713
Practice Address - Country:US
Practice Address - Phone:847-318-5360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-10
Last Update Date:2018-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL299506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist