MEDICARE: PAIGE AVERY PETRANDO CCC-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	242006120	IL
2	235Z00000X	Speech-Language Pathologist	146016142	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144837840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAIGE AVERY PETRANDO CCC-SLP

Provider Business Mailing Address
First Line	:	7844 W GOLF DR
Second Line	:
City	:	PALOS HEIGHTS
State	:	IL
Zip	:	60463-1964
Country	:	US
Telephone Number	:	203-927-5975
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 N GREEN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60642-5996
Country	:	US
Telephone Number	:	203-927-5975
Fax Number	:

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

Provider Enumeration Date	:	09/26/2020
Last Update Date	:	01/11/2026

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Directions to “ PAIGE AVERY PETRANDO CCC-SLP” Practice Location

Language	Start Address	Practice Location

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