MEDICARE: MRS. ADRIENNE LOURY M.A.

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	146006962	IL

General Provider Information

NPI Number	:	1003111899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADRIENNE LOURY M.A.

Provider Business Mailing Address
First Line	:	7505 S ABERDEEN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-2951
Country	:	US
Telephone Number	:	773-308-4242
Fax Number	:	773-488-3903

Provider Business Practice Location Address
First Line	:	7505 S ABERDEEN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60620-2951
Country	:	US
Telephone Number	:	773-308-4242
Fax Number	:	773-488-3903

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

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	06/05/2012

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Directions to “ MRS. ADRIENNE LOURY M.A.” Practice Location

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