MEDICARE: JESSICA KATHERINE PATNOUDES 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	146007726	IL

General Provider Information

NPI Number	:	1750410601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA KATHERINE PATNOUDES SLP

Provider Business Mailing Address
First Line	:	809 BARTON DR
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-7735
Country	:	US
Telephone Number	:	708-738-0852
Fax Number	:	815-723-2455

Provider Business Practice Location Address
First Line	:	809 BARTON DR
Second Line	:
City	:	OSWEGO
State	:	IL
Zip	:	60543-7735
Country	:	US
Telephone Number	:	708-738-0852
Fax Number	:	815-723-2455

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	09/20/2011

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