MEDICARE: MRS. SHARON LYNN ROSENBLOOM MA, CCC-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
1	235Z00000X	Speech-Language Pathologist	146010081	IL

General Provider Information

NPI Number	:	1407206345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON LYNN ROSENBLOOM MA, CCC-SLP

Provider Business Mailing Address
First Line	:	3732 N WAYNE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-7160
Country	:	US
Telephone Number	:	847-404-7858
Fax Number	:	224-655-2213

Provider Business Practice Location Address
First Line	:	3732 N WAYNE AVE APT 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-7160
Country	:	US
Telephone Number	:	847-404-7858
Fax Number	:	224-655-2213

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

Provider Enumeration Date	:	06/21/2016
Last Update Date	:	06/12/2020

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