MEDICARE: MARJORIE WILKEY

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		IL

General Provider Information

NPI Number	:	1548355449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE WILKEY

Provider Business Mailing Address
First Line	:	1640 W ROOSEVELT RD
Second Line	:	ROOM 336 (M/C 628)
City	:	CHICAGO
State	:	IL
Zip	:	60608-1316
Country	:	US
Telephone Number	:	312-413-1563
Fax Number	:	312-413-1993

Provider Business Practice Location Address
First Line	:	1640 W ROOSEVELT RD
Second Line	:	ROOM 336 (M/C 628)
City	:	CHICAGO
State	:	IL
Zip	:	60608-1316
Country	:	US
Telephone Number	:	312-413-1563
Fax Number	:	312-413-1993

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

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	07/08/2007

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Practice Location Address:

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Directions to “ MARJORIE WILKEY ” Practice Location

Language	Start Address	Practice Location

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