MEDICARE: KAY RUTHERFORD SLPA

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	2355S0801X	Speech-Language Assistant	217000292	IL

General Provider Information

NPI Number	:	1003258476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAY RUTHERFORD SLPA

Provider Business Mailing Address
First Line	:	5028 N SPRINGFIELD AVE
Second Line	:	3W
City	:	CHICAGO
State	:	IL
Zip	:	60625-3194
Country	:	US
Telephone Number	:	773-267-4692
Fax Number	:

Provider Business Practice Location Address
First Line	:	5028 N SPRINGFIELD AVE
Second Line	:	3W
City	:	CHICAGO
State	:	IL
Zip	:	60625-3194
Country	:	US
Telephone Number	:	773-267-4692
Fax Number	:

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

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	07/25/2013

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Directions to “ KAY RUTHERFORD SLPA” Practice Location

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