MEDICARE: ERIN WEBER HEDLIN MS 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		IL

General Provider Information

NPI Number	:	1376620153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN WEBER HEDLIN MS CCC SLP L

Provider Business Mailing Address
First Line	:	525 W HAWTHORNE PL
Second Line	:	# 1503
City	:	CHICAGO
State	:	IL
Zip	:	60657-2907
Country	:	US
Telephone Number	:	201-320-3114
Fax Number	:	484-210-2342

Provider Business Practice Location Address
First Line	:	525 W HAWTHORNE PL
Second Line	:	# 1503
City	:	CHICAGO
State	:	IL
Zip	:	60657-2907
Country	:	US
Telephone Number	:	201-320-3114
Fax Number	:	484-210-2342

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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