MEDICARE: EMILY BLOCK

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	146010265	IL

General Provider Information

NPI Number	:	1376854265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY BLOCK

Provider Business Mailing Address
First Line	:	4371 PRINCETON LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-6755
Country	:	US
Telephone Number	:	630-346-5728
Fax Number	:	224-256-2076

Provider Business Practice Location Address
First Line	:	4371 PRINCETON LN
Second Line	:
City	:	LAKE IN THE HILLS
State	:	IL
Zip	:	60156-6755
Country	:	US
Telephone Number	:	630-346-5728
Fax Number	:	224-256-2076

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

Provider Enumeration Date	:	06/25/2010
Last Update Date	:	04/15/2015

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Directions to “ EMILY BLOCK ” Practice Location

Language	Start Address	Practice Location

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