Provider Demographics
NPI:1265704829
Name:MRAZ, PATRICIA MARY (CCC-SLP/L)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MARY
Last Name:MRAZ
Suffix:
Gender:F
Credentials:CCC-SLP/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10654 GIGI DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2879
Mailing Address - Country:US
Mailing Address - Phone:708-280-8933
Mailing Address - Fax:
Practice Address - Street 1:3700 W 103RD ST
Practice Address - Street 2:LUDDEN CLINIC
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60655-3105
Practice Address - Country:US
Practice Address - Phone:177-329-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-29
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146007880235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist