MEDICARE: NICOLE RUSCHMEYER M.A., CCC-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	146008341	IL

General Provider Information

NPI Number	:	1609108422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE RUSCHMEYER M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	3134 N CLIFTON AVE APT 2W
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3335
Country	:	US
Telephone Number	:	773-756-8023
Fax Number	:

Provider Business Practice Location Address
First Line	:	3134 N CLIFTON AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-3335
Country	:	US
Telephone Number	:	773-756-8023
Fax Number	:

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

Provider Enumeration Date	:	02/03/2010
Last Update Date	:	04/08/2012

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