MEDICARE: DARCY A DOETCH M.A., 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	146.007931	IL

General Provider Information

NPI Number	:	1629302021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARCY A DOETCH M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	622 S 4TH ST
Second Line	:
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-3972
Country	:	US
Telephone Number	:	630-587-2166
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 E CHICAGO AVE
Second Line	:	SUITE 151
City	:	NAPERVILLE
State	:	IL
Zip	:	60540-5526
Country	:	US
Telephone Number	:	630-305-6039
Fax Number	:

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

Provider Enumeration Date	:	10/01/2009
Last Update Date	:	10/01/2009

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