MEDICARE: MS. BOBETTE T KIESER 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	12070051	IL

General Provider Information

NPI Number	:	1215160270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BOBETTE T KIESER CCC-SLP

Provider Business Mailing Address
First Line	:	14722 S PENN RD
Second Line	:
City	:	PLAINFIELD
State	:	IL
Zip	:	60544-2828
Country	:	US
Telephone Number	:	815-690-4586
Fax Number	:

Provider Business Practice Location Address
First Line	:	1048 OGDEN AVE
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60515-2894
Country	:	US
Telephone Number	:	630-810-1200
Fax Number	:

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

Provider Enumeration Date	:	08/25/2009
Last Update Date	:	08/25/2009

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