MEDICARE: MR. ERNEST ALFRED CHERULLO III SPEECH PATHOLOGIST

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

General Provider Information

NPI Number	:	1063562452
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ERNEST ALFRED CHERULLO III SPEECH PATHOLOGIST

Provider Business Mailing Address
First Line	:	4001 W 104TH ST APT 101A
Second Line	:
City	:	OAK LAWN
State	:	IL
Zip	:	60453-6220
Country	:	US
Telephone Number	:	773-860-9465
Fax Number	:

Provider Business Practice Location Address
First Line	:	3617 N TRIPP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3038
Country	:	US
Telephone Number	:	773-727-0340
Fax Number	:

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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