MEDICARE: SPEECHEASE PLLC

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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1518584630
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECHEASE PLLC

Provider Business Mailing Address
First Line	:	973 WALNUT RIDGE CT
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-2103
Country	:	US
Telephone Number	:	847-529-4505
Fax Number	:

Provider Business Practice Location Address
First Line	:	973 WALNUT RIDGE CT
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-2103
Country	:	US
Telephone Number	:	847-529-4505
Fax Number	:

Authorized Official
Title or Position	:	OWNER/ SLP
Name	:	KENDRA SHERRY DEMARCO
Credential	:	MA, CCC-SLP/L
Telephone Number	:	847-529-4505

Provider Enumeration Date	:	07/06/2020
Last Update Date	:	07/06/2020

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