MEDICARE: MS. ESTHER AYZENBERG 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	146009036	IL

General Provider Information

NPI Number	:	1306025853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ESTHER AYZENBERG CCC-SLP

Provider Business Mailing Address
First Line	:	3225 W FULLERTON AVE
Second Line	:	APT 2SE
City	:	CHICAGO
State	:	IL
Zip	:	60647-7037
Country	:	US
Telephone Number	:	847-975-8555
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 W FULLERTON AVE
Second Line	:	APT 2SE
City	:	CHICAGO
State	:	IL
Zip	:	60647-7037
Country	:	US
Telephone Number	:	847-975-8555
Fax Number	:	888-971-7142

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

Provider Enumeration Date	:	11/01/2007
Last Update Date	:	02/10/2015

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