MEDICARE: MS. GWENDOLYN SUE JULIAN SPEECH PATHOLOGIST

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		IL

General Provider Information

NPI Number	:	1003025917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GWENDOLYN SUE JULIAN SPEECH PATHOLOGIST

Provider Business Mailing Address
First Line	:	PO BOX 39182
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-0182
Country	:	US
Telephone Number	:	773-836-2393
Fax Number	:	773-836-0110

Provider Business Practice Location Address
First Line	:	1652 N LOCKWOOD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60639-4306
Country	:	US
Telephone Number	:	773-836-2393
Fax Number	:	773-836-0110

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

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	07/08/2007

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Directions to “ MS. GWENDOLYN SUE JULIAN SPEECH PATHOLOGIST” Practice Location

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