MEDICARE: MS. ANN BULMASH SELIN 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		IL

General Provider Information

NPI Number	:	1407029226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANN BULMASH SELIN M.A.

Provider Business Mailing Address
First Line	:	1307 S WABASH AVE
Second Line	:	APT. 401
City	:	CHICAGO
State	:	IL
Zip	:	60605-2620
Country	:	US
Telephone Number	:	312-435-9208
Fax Number	:	312-435-9210

Provider Business Practice Location Address
First Line	:	2710 N CLARK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-1503
Country	:	US
Telephone Number	:	773-244-0005
Fax Number	:

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

Provider Enumeration Date	:	04/13/2008
Last Update Date	:	04/13/2008

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