MEDICARE: SPEECH IN THE CITY, LLC

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		IL

General Provider Information

NPI Number	:	1689745812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH IN THE CITY, LLC

Provider Business Mailing Address
First Line	:	2105 N SOUTHPORT AVE UNIT 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4044
Country	:	US
Telephone Number	:
Fax Number	:	773-388-8914

Provider Business Practice Location Address
First Line	:	2105 N SOUTHPORT AVE UNIT 202
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-4044
Country	:	US
Telephone Number	:	773-388-8918
Fax Number	:	773-388-8914

Authorized Official
Title or Position	:	OWNER, SPEECH-PATHOLOGIST
Name	:	TERRI E GARTENBERG
Credential	:	PHD, CCC-SLP
Telephone Number	:	773-388-8918

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	08/16/2007

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Directions to “SPEECH IN THE CITY, LLC ” Practice Location

Language	Start Address	Practice Location

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