MEDICARE: MS. CAITLIN MARIE BRICE MS, 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

General Provider Information

NPI Number	:	1285838169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAITLIN MARIE BRICE MS, CCC-SLP

Provider Business Mailing Address
First Line	:	3928 W CORNELIA AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5006
Country	:	US
Telephone Number	:	617-543-2755
Fax Number	:

Provider Business Practice Location Address
First Line	:	3928 W CORNELIA AVE FL 1
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-5006
Country	:	US
Telephone Number	:	617-543-2755
Fax Number	:

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

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	08/22/2008

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