MEDICARE: ANGELA HIGGINBOTHAM-MONROE SPEECH PATHOLOGIST

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	146.003206	IL

General Provider Information

NPI Number	:	1649718156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA HIGGINBOTHAM-MONROE SPEECH PATHOLOGIST

Provider Business Mailing Address
First Line	:	1717 S PRAIRIE AVE APT 1306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4337
Country	:	US
Telephone Number	:	312-771-1511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1717 S PRAIRIE AVE APT 1306
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-4337
Country	:	US
Telephone Number	:	312-771-1511
Fax Number	:

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

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	02/03/2017

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