MEDICARE: SPEECH PLUS, P.C.

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	146002834	IL

General Provider Information

NPI Number	:	1336184720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH PLUS, P.C.

Provider Business Mailing Address
First Line	:	10071 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1272
Country	:	US
Telephone Number	:	815-464-6069
Fax Number	:	815-464-6970

Provider Business Practice Location Address
First Line	:	10071 W LINCOLN HWY
Second Line	:
City	:	FRANKFORT
State	:	IL
Zip	:	60423-1279
Country	:	US
Telephone Number	:	815-464-6069
Fax Number	:	815-464-6970

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	RENEE H. MATLOCK
Credential	:	M.A., CCC SLP
Telephone Number	:	815-464-6069

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	12/23/2008

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Directions to “SPEECH PLUS, P.C. ” Practice Location

Language	Start Address	Practice Location

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