MEDICARE: SAMANTHA ISAACSON

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	235Z00000X	Speech-Language Pathologist	242001060	IL

General Provider Information

NPI Number	:	1114161171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA ISAACSON

Provider Business Mailing Address
First Line	:	121 W CHESTNUT ST
Second Line	:	APT 1701
City	:	CHICAGO
State	:	IL
Zip	:	60610-3175
Country	:	US
Telephone Number	:	847-702-5810
Fax Number	:

Provider Business Practice Location Address
First Line	:	534 W CORNELIA AVE
Second Line	:	UNIT 3N
City	:	CHICAGO
State	:	IL
Zip	:	60657-2746
Country	:	US
Telephone Number	:	312-848-6315
Fax Number	:

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

Provider Enumeration Date	:	04/21/2009
Last Update Date	:	04/21/2009

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Directions to “ SAMANTHA ISAACSON ” Practice Location

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