MEDICARE: PHYLLIS SAUNDERS

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	:	1639293962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHYLLIS SAUNDERS

Provider Business Mailing Address
First Line	:	814 UNION DR
Second Line	:
City	:	UNIVERSITY PARK
State	:	IL
Zip	:	60466-3033
Country	:	US
Telephone Number	:	708-534-0987
Fax Number	:	708-534-3987

Provider Business Practice Location Address
First Line	:	814 UNION DR
Second Line	:
City	:	UNIVERSITY PARK
State	:	IL
Zip	:	60466-3033
Country	:	US
Telephone Number	:	708-534-0987
Fax Number	:	708-534-3987

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

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	07/08/2007

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Directions to “ PHYLLIS SAUNDERS ” Practice Location

Language	Start Address	Practice Location

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