Provider Demographics
NPI:1649968793
Name:MAITRA, MEGHA (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MEGHA
Middle Name:
Last Name:MAITRA
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N GREEN ST STE 405
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-5473
Mailing Address - Country:US
Mailing Address - Phone:312-392-1640
Mailing Address - Fax:
Practice Address - Street 1:700 N GREEN ST STE 405
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-5473
Practice Address - Country:US
Practice Address - Phone:312-392-1640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-26
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.015713235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist