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NPI Code Detail

MEDICARE: ELIZABETH MAEVE NOLAN M.S. CCC-SLP

MEDICARE: ELIZABETH MAEVE NOLAN M.S. CCC-SLP
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
1235Z00000XSpeech-Language Pathologist146.013774IL

General Provider Information

NPI Number : 1013428788
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH MAEVE NOLAN M.S. CCC-SLP
Provider Business Mailing Address
First Line : 4560 W 103RD ST STE 2
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-4870
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4560 W 103RD ST STE 2
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-4870
Country : US
Telephone Number : 708-860-5015
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2017
Last Update Date : 10/20/2017

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