MEDICARE: RYAN JAGNANDAN M.S., 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	146.012647	IL

General Provider Information

NPI Number	:	1396140257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN JAGNANDAN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	3755 N DAMEN AVE
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60618-4948
Country	:	US
Telephone Number	:	313-443-3261
Fax Number	:

Provider Business Practice Location Address
First Line	:	3755 N DAMEN AVE
Second Line	:	UNIT 1
City	:	CHICAGO
State	:	IL
Zip	:	60618-4948
Country	:	US
Telephone Number	:	313-443-3261
Fax Number	:

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

Provider Enumeration Date	:	11/04/2014
Last Update Date	:	07/09/2015

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Directions to “ RYAN JAGNANDAN M.S., CCC-SLP” Practice Location

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