Active NPI
Maciel Roa
- Speech-Language Pathologist
- Forest Park, IL
National Provider Identifier
1659072387
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- 242.018634
- Practice address
- 7423 Madison St
Forest Park, IL 60130-1502 - Phone
- (708) 435-4130
- NPI assigned
- Mar 10, 2023
- Last updated
- Jul 11, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | 242.018634 | IL | Primary |
Addresses
Primary practice location
7423 Madison St
Forest Park, IL 60130-1502
Mailing address
2535 Gunderson Ave
Berwyn, IL 60402-2645
Phone (773) 574-1106
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| BACB829782 | IL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678406400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783728000000",
"number": "1659072387",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2535 GUNDERSON AVE",
"city": "BERWYN",
"state": "IL",
"postal_code": "604022645",
"telephone_number": "773-574-1106"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7423 MADISON ST",
"city": "FOREST PARK",
"state": "IL",
"postal_code": "601301502",
"telephone_number": "708-435-4130"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROA",
"first_name": "MACIEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-10",
"last_updated": "2026-07-11",
"certification_date": "2026-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "IL",
"license": "242.018634",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.