MEDICARE: MARGO A LEAVITT 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
1	235Z00000X	Speech-Language Pathologist	146.008609	IL

General Provider Information

NPI Number	:	1033362025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGO A LEAVITT M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2333 W SAINT PAUL AVE APT 326
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5395
Country	:	US
Telephone Number	:	847-894-6535
Fax Number	:

Provider Business Practice Location Address
First Line	:	2333 W SAINT PAUL AVE APT 326
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-5395
Country	:	US
Telephone Number	:	847-894-6535
Fax Number	:

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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Directions to “ MARGO A LEAVITT M.S. CCC-SLP” Practice Location

Language	Start Address	Practice Location

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