MEDICARE: SAMANTHA LYNN DEUTSCH M.S., CCC-SLP

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	146009879	IL

General Provider Information

NPI Number	:	1225385578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA LYNN DEUTSCH M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2144 W SCHILLER ST
Second Line	:	UNIT 2B
City	:	CHICAGO
State	:	IL
Zip	:	60622-3038
Country	:	US
Telephone Number	:	847-774-0582
Fax Number	:

Provider Business Practice Location Address
First Line	:	2144 W SCHILLER ST
Second Line	:	UNIT 2B
City	:	CHICAGO
State	:	IL
Zip	:	60622-3038
Country	:	US
Telephone Number	:	847-774-0582
Fax Number	:

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

Provider Enumeration Date	:	08/06/2012
Last Update Date	:	08/06/2012

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