MEDICARE: MARY ELLEN SOLBERG 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		IL

General Provider Information

NPI Number	:	1205344850
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELLEN SOLBERG SLP

Provider Business Mailing Address
First Line	:	406 OWEN CT
Second Line	:
City	:	PROSPECT HTS
State	:	IL
Zip	:	60070-1327
Country	:	US
Telephone Number	:	847-342-8905
Fax Number	:

Provider Business Practice Location Address
First Line	:	406 OWEN CT
Second Line	:
City	:	PROSPECT HTS
State	:	IL
Zip	:	60070-1327
Country	:	US
Telephone Number	:	224-567-2478
Fax Number	:

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

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	09/29/2022

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Directions to “ MARY ELLEN SOLBERG SLP” Practice Location

Language	Start Address	Practice Location

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