MEDICARE: AMANDA BROOKE MEUSER MA 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	146.013948	IL

General Provider Information

NPI Number	:	1083383988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA BROOKE MEUSER MA CCC- SLP

Provider Business Mailing Address
First Line	:	604 DAUPHINE CT
Second Line	:
City	:	NORTHBROOK
State	:	IL
Zip	:	60062-2256
Country	:	US
Telephone Number	:	847-284-4604
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 W LAKE AVE
Second Line	:
City	:	GLENVIEW
State	:	IL
Zip	:	60026-1239
Country	:	US
Telephone Number	:	847-486-4647
Fax Number	:

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

Provider Enumeration Date	:	09/13/2021
Last Update Date	:	12/02/2022

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