MEDICARE: MRS. KATHLEEN BEATRICE ALFORD-YOUNG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1013160027
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHLEEN BEATRICE ALFORD-YOUNG

Provider Business Mailing Address
First Line	:	7631 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-2318
Country	:	US
Telephone Number	:	773-723-5646
Fax Number	:	773-723-5646

Provider Business Practice Location Address
First Line	:	7631 S WABASH AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60619-2318
Country	:	US
Telephone Number	:	773-723-5646
Fax Number	:	773-723-5646

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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