MEDICARE: MORE THAN WORDS PEDIATRICS, INC.

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	252Y00000X	Early Intervention Provider Agency	146010344	IL

General Provider Information

NPI Number	:	1336409432
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MORE THAN WORDS PEDIATRICS, INC.

Provider Business Mailing Address
First Line	:	748 WILLOW SPRING HILL DR
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2067
Country	:	US
Telephone Number	:	618-660-8416
Fax Number	:	618-628-8207

Provider Business Practice Location Address
First Line	:	748 WILLOW SPRING HILL DR
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2067
Country	:	US
Telephone Number	:	618-660-8416
Fax Number	:	618-628-8207

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. DENELLE MARIE WHITLATCH
Credential	:	M.A. CCC-SLP
Telephone Number	:	618-660-8416

Provider Enumeration Date	:	05/22/2012
Last Update Date	:	05/22/2012

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