MEDICARE: MRS. ELIZABETH ANN NORDBY MA CCCSLPL

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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1635115	OTHER	IL	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1134227879
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELIZABETH ANN NORDBY MA CCCSLPL

Provider Business Mailing Address
First Line	:	1016 N MARSHFIELD AVE
Second Line	:	# 1
City	:	CHICAGO
State	:	IL
Zip	:	60622-3820
Country	:	US
Telephone Number	:	773-486-0176
Fax Number	:	773-486-0176

Provider Business Practice Location Address
First Line	:	1016 N MARSHFIELD AVE
Second Line	:	# 1
City	:	CHICAGO
State	:	IL
Zip	:	60622-3820
Country	:	US
Telephone Number	:	773-220-6812
Fax Number	:	773-486-0176

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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