MEDICARE: KATY WHALEN CCC-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	146.012290	IL

General Provider Information

NPI Number	:	1558703082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATY WHALEN CCC-SLP-L

Provider Business Mailing Address
First Line	:	501 S LYONS RD
Second Line	:
City	:	WAVERLY
State	:	IL
Zip	:	62692-6066
Country	:	US
Telephone Number	:	217-248-8240
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 S LYONS RD
Second Line	:
City	:	WAVERLY
State	:	IL
Zip	:	62692-6066
Country	:	US
Telephone Number	:	217-248-8240
Fax Number	:

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

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	10/08/2014

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Directions to “ KATY WHALEN CCC-SLP-L” Practice Location

Language	Start Address	Practice Location

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