MEDICARE: RISE THROUGH LEARNING CO.

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
2	103TS0200X	School Psychologist	1826202	IL

General Provider Information

NPI Number	:	1316457542
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RISE THROUGH LEARNING CO.

Provider Business Mailing Address
First Line	:	3159 N SEMINARY AVE APT 307
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3359
Country	:	US
Telephone Number	:	248-821-9152
Fax Number	:

Provider Business Practice Location Address
First Line	:	3159 N SEMINARY AVE APT 307
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657
Country	:	US
Telephone Number	:	248-821-9152
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER, SCHOOL PSYCHOLOGIST
Name	:	KRISTEN SUDNIK
Credential	:
Telephone Number	:	248-821-9152

Provider Enumeration Date	:	10/02/2017
Last Update Date	:	06/14/2018

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Directions to “RISE THROUGH LEARNING CO. ” Practice Location

Language	Start Address	Practice Location

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