MEDICARE: FAYE DIANE CAMPAGNA M.A. 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	146008258	IL
2	235Z00000X	Speech-Language Pathologist	146.008258	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01635796	OTHER	IL	BCBS PPO

General Provider Information

NPI Number	:	1306935531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FAYE DIANE CAMPAGNA M.A. CCC-SLP/L

Provider Business Mailing Address
First Line	:	233 S KENILWORTH AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-3115
Country	:	US
Telephone Number	:	815-751-8344
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 S KENILWORTH AVE
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-3115
Country	:	US
Telephone Number	:	815-751-8344
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	03/17/2018

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Directions to “ FAYE DIANE CAMPAGNA M.A. CCC-SLP/L” Practice Location

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