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General NPI Number Information
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NPI Number | 1851805410
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Entity Type | Organization
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Legal Business Name | JAMIE TRAILOV SPEECH PATHOLOGY, P.C.
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Dates
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Enumeration Date | 11/18/2017
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Last Update Date | 09/02/2020
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Provider Practice Location Address
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Address Line | 1041 W WOLFRAM ST
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City | CHICAGO
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State | IL
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Zip | 60657-4327
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Country | US
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Telephone | 630-460-4663
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Fax |
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Provider Business Mailing Address
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Address Line | 1041 W WOLFRAM ST
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City | CHICAGO
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State | IL
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Zip | 60657-4327
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Country | US
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Telephone | 630-460-4663
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMIE TRAILOV
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Credential |
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Telephone | 630-460-4663
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 060.012178
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License Number State | IL
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