MEDICARE: ALLISON AMESQUITA MS, 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	146014904	IL

General Provider Information

NPI Number	:	1588442263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON AMESQUITA MS, CCC-SLP/L

Provider Business Mailing Address
First Line	:	5747 S RUTHERFORD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-3236
Country	:	US
Telephone Number	:	630-577-7243
Fax Number	:

Provider Business Practice Location Address
First Line	:	5747 S RUTHERFORD AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60638-3236
Country	:	US
Telephone Number	:	630-577-7243
Fax Number	:

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

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	10/24/2023

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Directions to “ ALLISON AMESQUITA MS, CCC-SLP/L” Practice Location

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