=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497978472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINE THERESE SCALA M.A., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/10/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 233 NORDIC RD
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60108-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-642-9793
-----------------------------------------------------
Fax | 630-295-8744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 233 NORDIC RD
-----------------------------------------------------
City | BLOOMINGDALE
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60108-1611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 708-642-9793
-----------------------------------------------------
Fax | 630-295-8744
-----------------------------------------------------
=====================================================
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 | 146006560
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------