MEDICARE: REBECCA KRITZMAN M.S. CF-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	242002099	IL

General Provider Information

NPI Number	:	1184907925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA KRITZMAN M.S. CF-SLP

Provider Business Mailing Address
First Line	:	1754 W WILSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4515
Country	:	US
Telephone Number	:	773-878-7868
Fax Number	:	773-751-2250

Provider Business Practice Location Address
First Line	:	1754 W WILSON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60640-4515
Country	:	US
Telephone Number	:	773-878-7868
Fax Number	:	773-751-2250

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

Provider Enumeration Date	:	09/27/2011
Last Update Date	:	03/14/2012

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