MEDICARE: TERRI GARTENBERG PH.D, 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		IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1627850	OTHER	IL	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1306992979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRI GARTENBERG PH.D, CCC-SLP

Provider Business Mailing Address
First Line	:	2105 N SOUTHPORT AVE UNIT 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4044
Country	:	US
Telephone Number	:	773-388-8918
Fax Number	:	773-388-8914

Provider Business Practice Location Address
First Line	:	2105 N SOUTHPORT AVE UNIT 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4044
Country	:	US
Telephone Number	:	773-388-8918
Fax Number	:	773-388-8914

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

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	07/08/2007

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Directions to “ TERRI GARTENBERG PH.D, CCC-SLP” Practice Location

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