MEDICARE: STEPHANIE MARCUS

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	146.012528	IL

General Provider Information

NPI Number	:	1750808382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MARCUS

Provider Business Mailing Address
First Line	:	1610 W GRAND AVE APT 2A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7853
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1610 W GRAND AVE APT 2A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-7853
Country	:	US
Telephone Number	:	847-329-8226
Fax Number	:

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

Provider Enumeration Date	:	08/24/2017
Last Update Date	:	03/04/2019

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Directions to “ STEPHANIE MARCUS ” Practice Location

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