MEDICARE: MRS. MICHELE PETRONE M.A CCC-SLP/L

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	146009253	IL

General Provider Information

NPI Number	:	1447435011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELE PETRONE M.A CCC-SLP/L

Provider Business Mailing Address
First Line	:	6155 N OVERHILL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1850
Country	:	US
Telephone Number	:	773-750-1468
Fax Number	:

Provider Business Practice Location Address
First Line	:	6155 N OVERHILL AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-1850
Country	:	US
Telephone Number	:	773-750-1468
Fax Number	:

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

Provider Enumeration Date	:	01/02/2008
Last Update Date	:	09/14/2011

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Directions to “ MRS. MICHELE PETRONE M.A CCC-SLP/L” Practice Location

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