MEDICARE: NANETTE MARIE BIRKY

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	146.000622	IL

General Provider Information

NPI Number	:	1881916195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANETTE MARIE BIRKY

Provider Business Mailing Address
First Line	:	515 W EXCHANGE ST
Second Line	:
City	:	DANVERS
State	:	IL
Zip	:	61732-9266
Country	:	US
Telephone Number	:	309-963-4493
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 W EXCHANGE ST
Second Line	:
City	:	DANVERS
State	:	IL
Zip	:	61732-9266
Country	:	US
Telephone Number	:	309-963-4493
Fax Number	:

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

Provider Enumeration Date	:	02/28/2010
Last Update Date	:	02/28/2010

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Directions to “ NANETTE MARIE BIRKY ” Practice Location

Language	Start Address	Practice Location

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