MEDICARE: JOANNA GATZIOLIS

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	146.011690	IL

General Provider Information

NPI Number	:	1013332808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA GATZIOLIS

Provider Business Mailing Address
First Line	:	3122 N KENMORE AVE
Second Line	:	2F
City	:	CHICAGO
State	:	IL
Zip	:	60657-3366
Country	:	US
Telephone Number	:	734-904-2937
Fax Number	:

Provider Business Practice Location Address
First Line	:	3122 N KENMORE AVE
Second Line	:	2F
City	:	CHICAGO
State	:	IL
Zip	:	60657-3366
Country	:	US
Telephone Number	:	734-904-2937
Fax Number	:

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

Provider Enumeration Date	:	03/03/2014
Last Update Date	:	03/03/2014

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Directions to “ JOANNA GATZIOLIS ” Practice Location

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