MEDICARE: KERRY DANAHY EBERT PHD, CCC

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	7709	MN
2	235Z00000X	Speech-Language Pathologist	146.010908	IL

General Provider Information

NPI Number	:	1265657928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KERRY DANAHY EBERT PHD, CCC

Provider Business Mailing Address
First Line	:	600 S PAULINA ST
Second Line	:	SUITE 1012
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-563-6034
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S PAULINA ST
Second Line	:	SUITE 1012
City	:	CHICAGO
State	:	IL
Zip	:	60612-3806
Country	:	US
Telephone Number	:	312-563-6034
Fax Number	:

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

Provider Enumeration Date	:	04/16/2007
Last Update Date	:	11/08/2011

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