MEDICARE: TALYA SMITH MA, CCC/SLP-L

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	146-007629	IL

General Provider Information

NPI Number	:	1245553916
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TALYA SMITH MA, CCC/SLP-L

Provider Business Mailing Address
First Line	:	2838 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7014
Country	:	US
Telephone Number	:	773-368-5074
Fax Number	:

Provider Business Practice Location Address
First Line	:	2838 W WELLINGTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-7014
Country	:	US
Telephone Number	:	773-368-5074
Fax Number	:

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

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	05/18/2016

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