MEDICARE: MRS. LOIS JEAN WENKEL

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14600003438	OTHER	IL	STATE LICENSE SPEECH PATH

General Provider Information

NPI Number	:	1003852476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOIS JEAN WENKEL

Provider Business Mailing Address
First Line	:	5622 WOODLANE DR
Second Line	:
City	:	WONDER LAKE
State	:	IL
Zip	:	60097-8123
Country	:	US
Telephone Number	:	815-653-9068
Fax Number	:	815-846-0693

Provider Business Practice Location Address
First Line	:	5622 WOODLANE DR
Second Line	:
City	:	WONDER LAKE
State	:	IL
Zip	:	60097-8123
Country	:	US
Telephone Number	:	815-653-9068
Fax Number	:	815-846-0693

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

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	07/08/2007

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