MEDICARE: MRS. NIKKI MINER MS, CCC-SLP

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	146009567	IL

General Provider Information

NPI Number	:	1003047895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NIKKI MINER MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1206 W HENDERSON ST # 2S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1491
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1206 W HENDERSON ST # 2S
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-1491
Country	:	US
Telephone Number	:	847-708-1116
Fax Number	:

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

Provider Enumeration Date	:	07/28/2009
Last Update Date	:	07/28/2009

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