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NPI Code Detail

MEDICARE: MRS. LISA K TRIMMER M.A. CCC-SLP

MEDICARE:  MRS. LISA K TRIMMER  M.A. 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
1235Z00000XSpeech-Language Pathologist146.009544IL

General Provider Information

NPI Number : 1447439799
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA K TRIMMER M.A. CCC-SLP
Provider Business Mailing Address
First Line : 324 W WILLOW ST
Second Line : APT 3F
City : CHICAGO
State : IL
Zip : 60614-5771
Country : US
Telephone Number : 773-578-5472
Fax Number :
Provider Business Practice Location Address
First Line : 6501 S PROMONTORY DR
Second Line :
City : CHICAGO
State : IL
Zip : 60649-1003
Country : US
Telephone Number : 773-256-5777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2007
Last Update Date : 12/21/2011

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Directions to “ MRS. LISA K TRIMMER M.A. CCC-SLP” Practice Location

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