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NPI Code Detail

MEDICARE: MRS. ADRIANA E MATOS DESAUTELS MHS, SLP-CF

MEDICARE: MRS. ADRIANA E MATOS DESAUTELS MHS, SLP-CF
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
1235Z00000XSpeech-Language Pathologist242.002633IL

General Provider Information

NPI Number : 1518383967
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ADRIANA E MATOS DESAUTELS MHS, SLP-CF
Provider Business Mailing Address
First Line : 10935 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-3127
Country : US
Telephone Number : 708-928-2000
Fax Number : 773-840-3504
Provider Business Practice Location Address
First Line : 10935 S HALSTED ST
Second Line :
City : CHICAGO
State : IL
Zip : 60628-3127
Country : US
Telephone Number : 708-928-2000
Fax Number : 773-840-3504
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2014
Last Update Date : 03/10/2014

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