MEDICARE: SYLLABLES SPEECH WORKSHOP LLC

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

General Provider Information

NPI Number	:	1235289620
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SYLLABLES SPEECH WORKSHOP LLC

Provider Business Mailing Address
First Line	:	3617 N TRIPP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3038
Country	:	US
Telephone Number	:	773-727-0340
Fax Number	:

Provider Business Practice Location Address
First Line	:	3617 N TRIPP AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-3038
Country	:	US
Telephone Number	:	773-727-0340
Fax Number	:

Authorized Official
Title or Position	:	CO-MANAGER
Name	:	MR. BRIAN JOSEPH TIJAN
Credential	:
Telephone Number	:	773-727-0340

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	08/22/2020

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Directions to “SYLLABLES SPEECH WORKSHOP LLC ” Practice Location

Language	Start Address	Practice Location

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