MEDICARE: ELISABETH ABBATACOLA MA

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	242001283	IL

General Provider Information

NPI Number	:	1740413889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISABETH ABBATACOLA MA

Provider Business Mailing Address
First Line	:	2025 W WALTON ST # 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4961
Country	:	US
Telephone Number	:	815-258-8574
Fax Number	:

Provider Business Practice Location Address
First Line	:	2025 W WALTON ST # 3
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60622-4961
Country	:	US
Telephone Number	:	815-258-8574
Fax Number	:

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

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	10/01/2015

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