MEDICARE: MS. SHANNON MARIE HILDEBRAND M.A.

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	SP. 9402	OH
2	235Z00000X	Speech-Language Pathologist	146.011460	IL

General Provider Information

NPI Number	:	1396992384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHANNON MARIE HILDEBRAND M.A.

Provider Business Mailing Address
First Line	:	1037 N WINCHESTER AVE
Second Line	:	#1
City	:	CHICAGO
State	:	IL
Zip	:	60622-3734
Country	:	US
Telephone Number	:	773-687-8711
Fax Number	:

Provider Business Practice Location Address
First Line	:	1037 N WINCHESTER AVE
Second Line	:	#1
City	:	CHICAGO
State	:	IL
Zip	:	60622-3734
Country	:	US
Telephone Number	:	773-687-8711
Fax Number	:

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

Provider Enumeration Date	:	08/21/2008
Last Update Date	:	01/29/2013

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Directions to “ MS. SHANNON MARIE HILDEBRAND M.A.” Practice Location

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