MEDICARE: KIMBERLY SHLAES

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1942626924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY SHLAES

Provider Business Mailing Address
First Line	:	2500 W BRADLEY PL STE 109
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4716
Country	:	US
Telephone Number	:	737-332-9439
Fax Number	:	773-754-8730

Provider Business Practice Location Address
First Line	:	2500 W BRADLEY PL STE 109
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-4716
Country	:	US
Telephone Number	:	737-332-9439
Fax Number	:	773-754-8730

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

Provider Enumeration Date	:	03/13/2014
Last Update Date	:	05/07/2020

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Directions to “ KIMBERLY SHLAES ” Practice Location

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