MEDICARE: MRS. MARIA REGALADO SLPA

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	2355S0801X	Speech-Language Assistant		IL

General Provider Information

NPI Number	:	1306982426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARIA REGALADO SLPA

Provider Business Mailing Address
First Line	:	102 GLENBROOK CIR
Second Line	:
City	:	GILBERTS
State	:	IL
Zip	:	60136-4079
Country	:	US
Telephone Number	:	630-460-8284
Fax Number	:	847-695-0595

Provider Business Practice Location Address
First Line	:	1049 E WILSON ST
Second Line	:	SUITE 100
City	:	BATAVIA
State	:	IL
Zip	:	60510-2474
Country	:	US
Telephone Number	:	630-761-0900
Fax Number	:	630-761-0909

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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