MEDICARE: PENNY SAGEZ

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	146.007598	IL

General Provider Information

NPI Number	:	1619386281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PENNY SAGEZ

Provider Business Mailing Address
First Line	:	1809 S EAST ST
Second Line	:
City	:	SOUTH JACKSONVILLE
State	:	IL
Zip	:	62650-3539
Country	:	US
Telephone Number	:	217-243-4914
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 S EAST ST
Second Line	:
City	:	SOUTH JACKSONVILLE
State	:	IL
Zip	:	62650-3539
Country	:	US
Telephone Number	:	217-243-4914
Fax Number	:

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

Provider Enumeration Date	:	08/08/2014
Last Update Date	:	08/08/2014

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Directions to “ PENNY SAGEZ ” Practice Location

Language	Start Address	Practice Location

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