MEDICARE: JESSIE RONAYNE

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	146014431	IL

General Provider Information

NPI Number	:	1568935658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSIE RONAYNE

Provider Business Mailing Address
First Line	:	3341 N SEMINARY AVE APT 2R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2257
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3341 N SEMINARY AVE APT 2R
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2257
Country	:	US
Telephone Number	:	734-658-8766
Fax Number	:

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

Provider Enumeration Date	:	01/10/2019
Last Update Date	:	01/10/2019

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Directions to “ JESSIE RONAYNE ” Practice Location

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