MEDICARE: DHOM SPEECH THERAPY SERVICES, 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	252Y00000X	Early Intervention Provider Agency		IL

General Provider Information

NPI Number	:	1386826220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DHOM SPEECH THERAPY SERVICES, P.C.

Provider Business Mailing Address
First Line	:	4889 N ASHLAND AVE APT 1W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3433
Country	:	US
Telephone Number	:	847-722-0421
Fax Number	:	773-275-6347

Provider Business Practice Location Address
First Line	:	4889 N ASHLAND AVE APT 1W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-3433
Country	:	US
Telephone Number	:	847-722-0421
Fax Number	:	773-275-6347

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	MELINDA M DHOM
Credential	:	M.S. CCC-SLP
Telephone Number	:	847-722-0421

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	12/03/2007

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