Provider Demographics
NPI:1669952073
Name:HERNANDEZ, ANA IBETH (MS, CCC-SLP)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:IBETH
Last Name:HERNANDEZ
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 1:1446 N DEARBORN ST APT 5C
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60610-1582
Mailing Address - Country:US
Mailing Address - Phone:972-896-7897
Mailing Address - Fax:
Practice Address - Street 1:1446 N DEARBORN ST APT 5C
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60610-1582
Practice Address - Country:US
Practice Address - Phone:972-896-7897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113056235Z00000X
IL146.014947235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist