MEDICARE: MARIANA SAFFAEI

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	146013711	IL

General Provider Information

NPI Number	:	1952896375
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANA SAFFAEI

Provider Business Mailing Address
First Line	:	2648 N SEMINARY AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-0791
Country	:	US
Telephone Number	:	126-980-8184
Fax Number	:

Provider Business Practice Location Address
First Line	:	2045 N LARRABEE ST APT 7206
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4406
Country	:	US
Telephone Number	:	269-808-1848
Fax Number	:

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

Provider Enumeration Date	:	06/27/2018
Last Update Date	:	06/24/2022

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Directions to “ MARIANA SAFFAEI ” Practice Location

Language	Start Address	Practice Location

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