MEDICARE: RENEE H MATLOCK 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	:	1265595235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE H MATLOCK SLP

Provider Business Mailing Address
First Line	:	10071 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1272
Country	:	US
Telephone Number	:	815-464-6069
Fax Number	:	815-464-6970

Provider Business Practice Location Address
First Line	:	10071 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1272
Country	:	US
Telephone Number	:	815-464-6069
Fax Number	:	815-464-6970

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

Provider Enumeration Date	:	12/19/2006
Last Update Date	:	07/08/2007

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Directions to “ RENEE H MATLOCK SLP” Practice Location

Language	Start Address	Practice Location

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