MEDICARE: ROBERTA A. WILTSE

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		IL

General Provider Information

NPI Number	:	1437665858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERTA A. WILTSE

Provider Business Mailing Address
First Line	:	2220 CHURCH ST
Second Line	:
City	:	JOHNSBURG
State	:	IL
Zip	:	60051-5910
Country	:	US
Telephone Number	:	815-385-6210
Fax Number	:

Provider Business Practice Location Address
First Line	:	2220 CHURCH ST
Second Line	:
City	:	JOHNSBURG
State	:	IL
Zip	:	60051-5910
Country	:	US
Telephone Number	:	815-385-6210
Fax Number	:

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	12/21/2017

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Directions to “ ROBERTA A. WILTSE ” Practice Location

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