MEDICARE: GAIL PETRO

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	146.003234	IL

General Provider Information

NPI Number	:	1457859217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL PETRO

Provider Business Mailing Address
First Line	:	1209 E BURR OAK DR
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004-1660
Country	:	US
Telephone Number	:	847-670-3400
Fax Number	:	847-670-3418

Provider Business Practice Location Address
First Line	:	1209 E BURR OAK DR
Second Line	:
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004-1660
Country	:	US
Telephone Number	:	847-670-3400
Fax Number	:	847-670-3418

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

Provider Enumeration Date	:	01/26/2018
Last Update Date	:	01/26/2018

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Directions to “ GAIL PETRO ” Practice Location

Language	Start Address	Practice Location

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