MEDICARE: MRS. JENNIFER ANN O'GRADY M.S. CCC-SLP/L

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		IL

General Provider Information

NPI Number	:	1609973049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JENNIFER ANN O'GRADY M.S. CCC-SLP/L

Provider Business Mailing Address
First Line	:	35050 N. FRONTAGE RD.
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041
Country	:	US
Telephone Number	:	847-587-5831
Fax Number	:	847-587-5831

Provider Business Practice Location Address
First Line	:	35050 N. FRONTAGE RD.
Second Line	:
City	:	INGLESIDE
State	:	IL
Zip	:	60041
Country	:	US
Telephone Number	:	847-587-5831
Fax Number	:	847-587-5831

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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Directions to “ MRS. JENNIFER ANN O'GRADY M.S. CCC-SLP/L” Practice Location

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