MEDICARE: AW THERAPY SERVICES, INC

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	1275604068	IL

General Provider Information

NPI Number	:	1003083023
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AW THERAPY SERVICES, INC

Provider Business Mailing Address
First Line	:	4717 W PATTERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3613
Country	:	US
Telephone Number	:	773-330-6220
Fax Number	:	773-439-2374

Provider Business Practice Location Address
First Line	:	4717 W PATTERSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3613
Country	:	US
Telephone Number	:	773-330-6220
Fax Number	:	773-439-2374

Authorized Official
Title or Position	:	SLP/PRESIDENT
Name	:	MS. ANNE WICKERT
Credential	:	M.S. CCC-SLP
Telephone Number	:	773-330-6220

Provider Enumeration Date	:	05/08/2008
Last Update Date	:	05/08/2008

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