=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154534717
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BELINDA TAYLOR-JONES M.A., CCC-SLP-L
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/08/2007
-----------------------------------------------------
Last Update Date | 07/11/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4343 W 77TH PL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60652-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-806-5694
-----------------------------------------------------
Fax | 773-789-2253
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4343 W 77TH PL
-----------------------------------------------------
City | CHICAGO
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60652-1206
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 312-806-5694
-----------------------------------------------------
Fax | 773-789-2253
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 146003334
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------