MEDICARE: JEANNE RANE BYERS SPRAETZ MA 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	SA 7563	FL
2	235Z00000X	Speech-Language Pathologist	146 003582	IL
3	235Z00000X	Speech-Language Pathologist	00805	IA
4	235Z00000X	Speech-Language Pathologist	363 154	WI

General Provider Information

NPI Number	:	1750357562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEANNE RANE BYERS SPRAETZ MA CCC SLP

Provider Business Mailing Address
First Line	:	1706 SUPERIOR AVE
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-2424
Country	:	US
Telephone Number	:	815-541-1857
Fax Number	:	815-273-4354

Provider Business Practice Location Address
First Line	:	1706 SUPERIOR AVE
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-2424
Country	:	US
Telephone Number	:	815-541-1857
Fax Number	:	815-273-4354

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

Provider Enumeration Date	:	02/23/2006
Last Update Date	:	02/25/2008

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