MEDICARE: ITA MEYSTEL

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	146010797	IL

General Provider Information

NPI Number	:	1164805909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ITA MEYSTEL

Provider Business Mailing Address
First Line	:	6725 N MOZART ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4309
Country	:	US
Telephone Number	:	773-262-1164
Fax Number	:

Provider Business Practice Location Address
First Line	:	6725 N MOZART ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60645-4309
Country	:	US
Telephone Number	:	773-262-1164
Fax Number	:

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

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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Directions to “ ITA MEYSTEL ” Practice Location

Language	Start Address	Practice Location

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