MEDICARE: MARY ANN RIZZUTO 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	146009400	IL

General Provider Information

NPI Number	:	1770749178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN RIZZUTO SLP

Provider Business Mailing Address
First Line	:	2536 W 100TH PL
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1032
Country	:	US
Telephone Number	:	708-837-4412
Fax Number	:

Provider Business Practice Location Address
First Line	:	2543 W 101ST ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60655-1043
Country	:	US
Telephone Number	:	708-837-4412
Fax Number	:

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

Provider Enumeration Date	:	08/05/2008
Last Update Date	:	05/01/2015

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Directions to “ MARY ANN RIZZUTO SLP” Practice Location

Language	Start Address	Practice Location

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