MEDICARE: SUSAN ANISH P.C.

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	01633987	OTHER	IL	BLUE SHIELD PROVIDER #

General Provider Information

NPI Number	:	1255396792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUSAN ANISH P.C.

Provider Business Mailing Address
First Line	:	7658 W FARRAGUT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-1704
Country	:	US
Telephone Number	:	773-467-0063
Fax Number	:

Provider Business Practice Location Address
First Line	:	7658 W FARRAGUT AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60656-1704
Country	:	US
Telephone Number	:	773-467-0063
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / SPEECH THERAPIST
Name	:	SUSAN E ANISH
Credential	:	M.S. CCC-SLP
Telephone Number	:	773-467-0063

Provider Enumeration Date	:	04/18/2006
Last Update Date	:	08/22/2020

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Directions to “SUSAN ANISH P.C. ” Practice Location

Language	Start Address	Practice Location

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