MEDICARE: MS. COREY MICHELLE FRIEDLI CF-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	2355S0801X	Speech-Language Assistant	242.003108	IL

General Provider Information

NPI Number	:	1376941161
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. COREY MICHELLE FRIEDLI CF-SLP

Provider Business Mailing Address
First Line	:	3136 S PRAIRIE AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3904
Country	:	US
Telephone Number	:	402-870-1605
Fax Number	:

Provider Business Practice Location Address
First Line	:	3136 S PRAIRIE AVE APT 2
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-3904
Country	:	US
Telephone Number	:	402-870-1605
Fax Number	:

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

Provider Enumeration Date	:	12/11/2014
Last Update Date	:	12/11/2014

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