MEDICARE: CAROLYN DAY B.S., M.ED.,

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	2355S0801X	Speech-Language Assistant	217000058	IL

General Provider Information

NPI Number	:	1164895983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN DAY B.S., M.ED.,

Provider Business Mailing Address
First Line	:	4800 S CHICAGO BEACH DR
Second Line	:	2002S
City	:	CHICAGO
State	:	IL
Zip	:	60615-7032
Country	:	US
Telephone Number	:	312-391-6929
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 S CHICAGO BEACH DR
Second Line	:	2002S
City	:	CHICAGO
State	:	IL
Zip	:	60615-7032
Country	:	US
Telephone Number	:	312-391-6929
Fax Number	:

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

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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