MEDICARE: AMALIA CONWAY 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		IL

General Provider Information

NPI Number	:	1457529265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMALIA CONWAY M.A., CCC-SLP/L

Provider Business Mailing Address
First Line	:	7416 N OKETO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-4429
Country	:	US
Telephone Number	:	773-792-9231
Fax Number	:	708-388-2996

Provider Business Practice Location Address
First Line	:	7416 N OKETO AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60631-4429
Country	:	US
Telephone Number	:	773-792-9231
Fax Number	:	708-388-2996

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

Provider Enumeration Date	:	02/14/2008
Last Update Date	:	02/14/2008

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Directions to “ AMALIA CONWAY M.A., CCC-SLP/L” Practice Location

Language	Start Address	Practice Location

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