Provider Demographics
NPI:1245372259
Name:VASILAKOPOULOS, MALINDA (MA)
Entity type:Individual
Prefix:MRS
First Name:MALINDA
Middle Name:
Last Name:VASILAKOPOULOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MINDY
Other - Middle Name:
Other - Last Name:VASILAKOPOULOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1101 31ST ST STE 110
Mailing Address - Street 2:
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60515-5562
Mailing Address - Country:US
Mailing Address - Phone:630-929-0122
Mailing Address - Fax:630-353-1114
Practice Address - Street 1:1101 31ST ST STE 110
Practice Address - Street 2:
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60515-5562
Practice Address - Country:US
Practice Address - Phone:708-929-0122
Practice Address - Fax:630-729-0134
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146006654235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist