MEDICARE: NEWSOME SPEECH AND LANGUAGE THERAPY P. C.

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

General Provider Information

NPI Number	:	1104290279
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWSOME SPEECH AND LANGUAGE THERAPY P. C.

Provider Business Mailing Address
First Line	:	6351 W MONTROSE AVE
Second Line	:	#304
City	:	CHICAGO
State	:	IL
Zip	:	60634-1563
Country	:	US
Telephone Number	:	773-889-8035
Fax Number	:	773-637-1976

Provider Business Practice Location Address
First Line	:	6351 W MONTROSE AVE
Second Line	:	#304
City	:	CHICAGO
State	:	IL
Zip	:	60634-1563
Country	:	US
Telephone Number	:	773-889-8035
Fax Number	:	773-637-1976

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MELODY HARTZOG
Credential	:
Telephone Number	:	773-889-8035

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	11/30/2015

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Directions to “NEWSOME SPEECH AND LANGUAGE THERAPY P. C. ” Practice Location

Language	Start Address	Practice Location

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