MEDICARE: MS. DANA RAMSEY AUD

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	147001281	IL
2	231HA2400X	Assistive Technology Practitioner Audiologist	147001281	IL

General Provider Information

NPI Number	:	1164679973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DANA RAMSEY AUD

Provider Business Mailing Address
First Line	:	606 S MILWAUKEE AVE
Second Line	:	UNIT B
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3235
Country	:	US
Telephone Number	:	708-638-4256
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 S MILWAUKEE AVE
Second Line	:	UNIT B
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-3235
Country	:	US
Telephone Number	:	708-638-4256
Fax Number	:

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

Provider Enumeration Date	:	08/22/2008
Last Update Date	:	09/05/2012

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