MEDICARE: MS. MELODY ALTHEA HARTZOG SLP-L

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	146.002044	IL

General Provider Information

NPI Number	:	1508987876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELODY ALTHEA HARTZOG SLP-L

Provider Business Mailing Address
First Line	:	PO BOX 5611
Second Line	:
City	:	RIVER FOREST
State	:	IL
Zip	:	60305-5611
Country	:	US
Telephone Number	:	773-889-8035
Fax Number	:	773-637-1976

Provider Business Practice Location Address
First Line	:	1233 S KARLOV AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60623-1213
Country	:	US
Telephone Number	:	773-889-8035
Fax Number	:	773-637-1976

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

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	07/08/2007

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