MEDICARE: ISABEL CHAIDEZ 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	2361924	IL

General Provider Information

NPI Number	:	1568970119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ISABEL CHAIDEZ SLP

Provider Business Mailing Address
First Line	:	517 CARRIAGE WAY
Second Line	:
City	:	SOUTH ELGIN
State	:	IL
Zip	:	60177-3292
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	130 E FOREST AVE
Second Line	:
City	:	WEST CHICAGO
State	:	IL
Zip	:	60185-3524
Country	:	US
Telephone Number	:	630-293-6010
Fax Number	:

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

Provider Enumeration Date	:	01/17/2018
Last Update Date	:	01/17/2018

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Directions to “ ISABEL CHAIDEZ SLP” Practice Location

Language	Start Address	Practice Location

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