MEDICARE: MRS. KAREN S SHEEHAN SPEECH THERAPIST

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	146003233	IL

General Provider Information

NPI Number	:	1609871482
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAREN S SHEEHAN SPEECH THERAPIST

Provider Business Mailing Address
First Line	:	10S510 HAVENS DR
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-5119
Country	:	US
Telephone Number	:	630-220-1690
Fax Number	:	630-910-6740

Provider Business Practice Location Address
First Line	:	10S510 HAVENS DR
Second Line	:
City	:	DOWNERS GROVE
State	:	IL
Zip	:	60516-5119
Country	:	US
Telephone Number	:	630-220-1690
Fax Number	:	630-910-6740

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	07/08/2007

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