MEDICARE: EMILY MASON

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	41360	CA
2	235Z00000X	Speech-Language Pathologist	242.002541	IL

General Provider Information

NPI Number	:	1497095731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY MASON

Provider Business Mailing Address
First Line	:	609 MIDWAY PARK
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-4228
Country	:	US
Telephone Number	:	630-217-9199
Fax Number	:

Provider Business Practice Location Address
First Line	:	1422 W WILLOW ST
Second Line	:	#101
City	:	CHICAGO
State	:	IL
Zip	:	60642-8978
Country	:	US
Telephone Number	:	312-399-0370
Fax Number	:

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

Provider Enumeration Date	:	02/24/2013
Last Update Date	:	06/19/2026

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Directions to “ EMILY MASON ” Practice Location

Language	Start Address	Practice Location

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