MEDICARE: LAURA YOUNGREN MA, 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
1	235Z00000X	Speech-Language Pathologist	146.00745	IL

General Provider Information

NPI Number	:	1528149721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA YOUNGREN MA, CCC-SLP

Provider Business Mailing Address
First Line	:	2649 N SOUTHPORT AVE
Second Line	:	#3
City	:	CHICAGO
State	:	IL
Zip	:	60614-1280
Country	:	US
Telephone Number	:	773-531-3556
Fax Number	:	773-822-0794

Provider Business Practice Location Address
First Line	:	3040 N WILTON AVE
Second Line	:	2ND FLOOR
City	:	CHICAGO
State	:	IL
Zip	:	60657-4424
Country	:	US
Telephone Number	:	773-531-3556
Fax Number	:	773-822-0794

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/27/2009

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