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NPI Code Detail

MEDICARE: CALLIE WILBAT CF-SLP

MEDICARE: CALLIE WILBAT CF-SLP
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
1235Z00000XSpeech-Language Pathologist242005041IL

General Provider Information

NPI Number : 1396228227
Entity Type Code : Individual
Provider Name (Legal Business Name) : CALLIE WILBAT CF-SLP
Provider Business Mailing Address
First Line : 924 WOODWARD AVE
Second Line :
City : DEERFIELD
State : IL
Zip : 60015-2867
Country : US
Telephone Number : 847-899-0675
Fax Number :
Provider Business Practice Location Address
First Line : 4505 S DREXEL BLVD
Second Line :
City : CHICAGO
State : IL
Zip : 60653-4301
Country : US
Telephone Number : 773-285-0550
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 09/06/2018

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Directions to “ CALLIE WILBAT CF-SLP” Practice Location

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