MEDICARE: MRS. C. ELIZABETH CHAMBERLAIN-LANE 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		IL

General Provider Information

NPI Number	:	1104825819
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. C. ELIZABETH CHAMBERLAIN-LANE SLP

Provider Business Mailing Address
First Line	:	135 N WILLIAMSBURG DR
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-3528
Country	:	US
Telephone Number	:	309-661-8823
Fax Number	:	309-661-8801

Provider Business Practice Location Address
First Line	:	135 N WILLIAMSBURG DR
Second Line	:
City	:	BLOOMINGTON
State	:	IL
Zip	:	61704-3528
Country	:	US
Telephone Number	:	309-661-8823
Fax Number	:	309-661-8801

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

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	07/08/2007

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Directions to “ MRS. C. ELIZABETH CHAMBERLAIN-LANE SLP” Practice Location

Language	Start Address	Practice Location

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