MEDICARE: MISS ELIZABETH D GUITREAU M.S., CCC-SLP

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	242003070	IL
2	235Z00000X	Speech-Language Pathologist	7106	LA

General Provider Information

NPI Number	:	1699156240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ELIZABETH D GUITREAU M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2115 N SEDGWICK ST
Second Line	:	APT 3C
City	:	CHICAGO
State	:	IL
Zip	:	60614-4778
Country	:	US
Telephone Number	:	225-323-2156
Fax Number	:

Provider Business Practice Location Address
First Line	:	2115 N SEDGWICK ST
Second Line	:	APT 3C
City	:	CHICAGO
State	:	IL
Zip	:	60614-4778
Country	:	US
Telephone Number	:	225-323-2156
Fax Number	:

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

Provider Enumeration Date	:	06/09/2015
Last Update Date	:	06/09/2015

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Directions to “ MISS ELIZABETH D GUITREAU M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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