=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588049308
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY KATHLEEN ALLEN SLPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/22/2015
-----------------------------------------------------
Last Update Date | 07/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1781 CONCORD DR
-----------------------------------------------------
City | GLENDALE HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60139-1896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-338-5227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1781 CONCORD DR
-----------------------------------------------------
City | GLENDALE HEIGHTS
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 60139-1896
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-338-5227
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | 217000142
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------