MEDICARE: MS. PATRICIA POLITANO 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	146.003653	IL

General Provider Information

NPI Number	:	1609885318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA POLITANO SLP

Provider Business Mailing Address
First Line	:	1640 WEST ROOSEVELT ROAD
Second Line	:	RM 413 DHSP (M/C 726)
City	:	CHICAGO
State	:	IL
Zip	:	60608-6904
Country	:	US
Telephone Number	:	312-413-1555
Fax Number	:	312-413-3709

Provider Business Practice Location Address
First Line	:	1640 W ROOSEVELT RD
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608-1316
Country	:	US
Telephone Number	:	312-143-1473
Fax Number	:

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	10/27/2016

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