MEDICARE: SUSAN PRUITT GRUHLKE

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	146.002658	IL

General Provider Information

NPI Number	:	1104326701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN PRUITT GRUHLKE

Provider Business Mailing Address
First Line	:	1204 W HEATHER LN
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-1155
Country	:	US
Telephone Number	:	847-902-6558
Fax Number	:

Provider Business Practice Location Address
First Line	:	2016 E SAINT JAMES ST
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60004-6461
Country	:	US
Telephone Number	:	224-409-7150
Fax Number	:	224-324-8455

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

Provider Enumeration Date	:	02/20/2018
Last Update Date	:	02/20/2018

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Directions to “ SUSAN PRUITT GRUHLKE ” Practice Location

Language	Start Address	Practice Location

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