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NPI Code Detail

MEDICARE: KENYATTA SCOTT STA

MEDICARE: KENYATTA SCOTT STA
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
12355S0801XSpeech-Language Assistant217.000239IL

General Provider Information

NPI Number : 1588961692
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENYATTA SCOTT STA
Provider Business Mailing Address
First Line : 4515 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630
Country : US
Telephone Number : 773-507-5507
Fax Number :
Provider Business Practice Location Address
First Line : 4515 N MILWAUKEE AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60630-3711
Country : US
Telephone Number : 773-507-5507
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/25/2011
Last Update Date : 02/25/2011

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Directions to “ KENYATTA SCOTT STA” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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