MEDICARE: JAMIE NANAVATI MS, CCC-SLP

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
2	235Z00000X	Speech-Language Pathologist	146012798	IL

General Provider Information

NPI Number	:	1588185987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE NANAVATI MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1314 W GRENSHAW ST UNIT B
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-4805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 N WELLS ST APT 3214
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6025
Country	:	US
Telephone Number	:	708-278-0035
Fax Number	:

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

Provider Enumeration Date	:	07/06/2017
Last Update Date	:	12/18/2024

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