MEDICARE: OLIVIA MOSSIDES M.S., SLP - 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	146017384	IL

General Provider Information

NPI Number	:	1316754914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA MOSSIDES M.S., SLP - CCC

Provider Business Mailing Address
First Line	:	345 N LA SALLE DR APT 709
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60654-6342
Country	:	US
Telephone Number	:	630-853-4277
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 W WELLINGTON AVE STE 3809
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-5147
Country	:	US
Telephone Number	:	773-296-3066
Fax Number	:

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

Provider Enumeration Date	:	12/17/2024
Last Update Date	:	12/17/2024

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Directions to “ OLIVIA MOSSIDES M.S., SLP - CCC” Practice Location

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