MEDICARE: CHRISTINE ALLISON DRISCOLL M.S., CCC-SLP/L

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	146013900	IL

General Provider Information

NPI Number	:	1275029415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINE ALLISON DRISCOLL M.S., CCC-SLP/L

Provider Business Mailing Address
First Line	:	2243 W THOMAS ST # 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-3515
Country	:	US
Telephone Number	:	630-417-2334
Fax Number	:

Provider Business Practice Location Address
First Line	:	1757 N KIMBALL AVE # 205A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-4805
Country	:	US
Telephone Number	:	630-417-2334
Fax Number	:

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

Provider Enumeration Date	:	07/10/2018
Last Update Date	:	08/16/2023

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