MEDICARE: BRITTANY MACCOLL MS

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	242001245	IL

General Provider Information

NPI Number	:	1578897245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRITTANY MACCOLL MS

Provider Business Mailing Address
First Line	:	410 W POLK AVE
Second Line	:
City	:	CHARLESTON
State	:	IL
Zip	:	61920-2557
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	410 W POLK AVE
Second Line	:
City	:	CHARLESTON
State	:	IL
Zip	:	61920-2557
Country	:	US
Telephone Number	:	815-725-9992
Fax Number	:

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

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	08/31/2023

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Directions to “ BRITTANY MACCOLL MS” Practice Location

Language	Start Address	Practice Location

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