MEDICARE: CASEY MALMAN

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		IL

General Provider Information

NPI Number	:	1396381067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY MALMAN

Provider Business Mailing Address
First Line	:	901 W MADISON ST UNIT 701
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-3372
Country	:	US
Telephone Number	:	847-715-6536
Fax Number	:

Provider Business Practice Location Address
First Line	:	901 W MADISON ST UNIT 701
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60607-3372
Country	:	US
Telephone Number	:	847-715-6536
Fax Number	:

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

Provider Enumeration Date	:	11/18/2019
Last Update Date	:	11/18/2019

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Directions to “ CASEY MALMAN ” Practice Location

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