MEDICARE: ALISON BONTHRON WORTH MA 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	146000865	IL

General Provider Information

NPI Number	:	1336204726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISON BONTHRON WORTH MA CCC SLP

Provider Business Mailing Address
First Line	:	13600 W WADSWORTH RD
Second Line	:
City	:	WADSWORTH
State	:	IL
Zip	:	60083-8606
Country	:	US
Telephone Number	:	847-505-1754
Fax Number	:

Provider Business Practice Location Address
First Line	:	13600 W WADSWORTH RD
Second Line	:
City	:	WADSWORTH
State	:	IL
Zip	:	60083-8606
Country	:	US
Telephone Number	:	847-505-1754
Fax Number	:

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

Provider Enumeration Date	:	12/26/2006
Last Update Date	:	03/17/2018

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