MEDICARE: MS. PATRICIA LYNN ROE M.H.S., 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	146-006395	IL

General Provider Information

NPI Number	:	1669616140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA LYNN ROE M.H.S., CCC, SLP/L

Provider Business Mailing Address
First Line	:	39 SYCAMORE CT
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5017
Country	:	US
Telephone Number	:	773-485-8336
Fax Number	:

Provider Business Practice Location Address
First Line	:	39 SYCAMORE CT
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5017
Country	:	US
Telephone Number	:	773-485-8336
Fax Number	:

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

Provider Enumeration Date	:	04/28/2009
Last Update Date	:	07/29/2019

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