MEDICARE: MS. KIMBERLY LAY FRAHER M.ED., 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	146-005843	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01632614	OTHER	IL	BC/BS OF IL PROV #

General Provider Information

NPI Number	:	1770558660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KIMBERLY LAY FRAHER M.ED., CCC-SLP

Provider Business Mailing Address
First Line	:	1530 N MAPLEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-1643
Country	:	US
Telephone Number	:	773-592-6953
Fax Number	:	773-435-6449

Provider Business Practice Location Address
First Line	:	1530 NORTH MAPLEWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622
Country	:	US
Telephone Number	:	773-782-3189
Fax Number	:	773-782-3189

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

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	04/07/2015

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Directions to “ MS. KIMBERLY LAY FRAHER M.ED., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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