MEDICARE: AISHA RASUL

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	2355S0801X	Speech-Language Assistant

General Provider Information

NPI Number	:	1891166740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AISHA RASUL

Provider Business Mailing Address
First Line	:	7406 CHUCKS WAY
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-5394
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7406 CHUCKS WAY
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-5394
Country	:	US
Telephone Number	:	469-879-4160
Fax Number	:

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

Provider Enumeration Date	:	10/16/2015
Last Update Date	:	10/16/2015

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Directions to “ AISHA RASUL ” Practice Location

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