MEDICARE: MS. JOSEPHINE LIZZETE AYALA

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	146.016589	IL

General Provider Information

NPI Number	:	1386516078
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOSEPHINE LIZZETE AYALA

Provider Business Mailing Address
First Line	:	4429 N LAWNDALE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-7120
Country	:	US
Telephone Number	:	773-791-6643
Fax Number	:

Provider Business Practice Location Address
First Line	:	4429 N LAWNDALE AVE APT 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-7120
Country	:	US
Telephone Number	:	773-791-6643
Fax Number	:

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

Provider Enumeration Date	:	09/22/2025
Last Update Date	:	09/22/2025

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