MEDICARE: MRS. CYNTHIA RODER

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	222Q00000X	Developmental Therapist

General Provider Information

NPI Number	:	1508056417
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CYNTHIA RODER

Provider Business Mailing Address
First Line	:	5355 W DAKIN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2521
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5355 W DAKIN ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60641-2521
Country	:	US
Telephone Number	:	773-398-2762
Fax Number	:

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	07/26/2007

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Directions to “ MRS. CYNTHIA RODER ” Practice Location

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