MEDICARE: ALEXANDRIA MCBRIDE M.S.

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	146012442	IL

General Provider Information

NPI Number	:	1104180942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDRIA MCBRIDE M.S.

Provider Business Mailing Address
First Line	:	312 SPRING AVE
Second Line	:
City	:	GLEN ELLYN
State	:	IL
Zip	:	60137-4826
Country	:	US
Telephone Number	:	402-517-8442
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 N 20TH AVE
Second Line	:
City	:	MELROSE PARK
State	:	IL
Zip	:	60160-1904
Country	:	US
Telephone Number	:	402-517-8442
Fax Number	:

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

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	10/03/2017

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