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NPI Code Detail

MEDICARE: CAITLIN ELIZABETH FAUNTLEROY

MEDICARE: CAITLIN ELIZABETH FAUNTLEROY
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 PathologistIL

General Provider Information

NPI Number : 1497043111
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAITLIN ELIZABETH FAUNTLEROY
Provider Business Mailing Address
First Line : 2236 N MAPLEWOOD AVE
Second Line : UNIT 2
City : CHICAGO
State : IL
Zip : 60647-3146
Country : US
Telephone Number : 615-519-1586
Fax Number :
Provider Business Practice Location Address
First Line : 1957 W DICKENS AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60614-3934
Country : US
Telephone Number : 773-698-6535
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2011
Last Update Date : 09/04/2015

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Directions to “ CAITLIN ELIZABETH FAUNTLEROY ” Practice Location

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