MEDICARE: DR. NANCY ANN CONGDON AU.D.

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	231H00000X	Audiologist		IL

General Provider Information

NPI Number	:	1114917150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY ANN CONGDON AU.D.

Provider Business Mailing Address
First Line	:	6800 MAIN ST
Second Line	:	#114
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-3493
Country	:	US
Telephone Number	:	630-963-6161
Fax Number	:	630-963-6162

Provider Business Practice Location Address
First Line	:	6800 MAIN ST
Second Line	:	#114
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-3493
Country	:	US
Telephone Number	:	630-963-6161
Fax Number	:	630-963-6162

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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