Individual provider Active NPI

Itzel G Abundis

  • Speech-Language Pathologist
  • Park Ridge, IL
National Provider Identifier
1184458606
Registry record updated Oct 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
146.017204 Issued in IL
Practice address
575 Busse Hwy Unit C
Park Ridge, IL 60068-3189
Phone
(815) 469-1500
NPI assigned
Aug 27, 2024
Last updated
Oct 4, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 146.017204 IL Primary

Addresses

Primary practice location

575 Busse Hwy Unit C
Park Ridge, IL 60068-3189

Mailing address

3019 N Luna Ave
Chicago, IL 60641-4847

Other identifiers 1

IdentifierTypeStateIssuer
1477602548MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241112000465 IL Practitioner - Qualified Speech Language Pathologist 2769916907 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
146.017204ILMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehensive Therapeutics LTD Speech-Language Pathologist CurrentSince Oct 4, 2024 Accepting new patients
Comprehensive Therapeutics LTD Speech-Language Pathologist CurrentSince Oct 4, 2024 Accepting new patients
Westside Childrens Therapy Speech-Language Pathologist PastSince Oct 6, 2024 Accepting new patients

Locations

1015 Oconor Ave
La Salle, IL 61301
Phone (224) 616-5446

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1728000000000",
    "number": "1184458606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3019 N LUNA AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606414847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 BUSSE HWY UNIT C",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600683189",
            "telephone_number": "815-469-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ABUNDIS",
        "first_name": "ITZEL",
        "middle_name": "G",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-27",
        "last_updated": "2024-10-04",
        "certification_date": "2024-10-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.017204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477602548",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.