MEDICARE: CARLIN O'DAY

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	146012167	IL

General Provider Information

NPI Number	:	1548792963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARLIN O'DAY

Provider Business Mailing Address
First Line	:	1636 N WELLS ST APT 2614
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6022
Country	:	US
Telephone Number	:	202-531-6517
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 N WELLS ST APT 2614
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-6022
Country	:	US
Telephone Number	:	202-531-6517
Fax Number	:

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

Provider Enumeration Date	:	04/03/2017
Last Update Date	:	04/03/2017

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Directions to “ CARLIN O'DAY ” Practice Location

Language	Start Address	Practice Location

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