MEDICARE: TINY VOICE THERAPY SERVICES

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	305S00000X	Point of Service	146011731	IL

General Provider Information

NPI Number	:	1760860589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TINY VOICE THERAPY SERVICES

Provider Business Mailing Address
First Line	:	601 E GARFIELD ST
Second Line	:
City	:	WATERMAN
State	:	IL
Zip	:	60556-9861
Country	:	US
Telephone Number	:	815-508-8327
Fax Number	:	815-264-3039

Provider Business Practice Location Address
First Line	:	601 E GARFIELD ST
Second Line	:
City	:	WATERMAN
State	:	IL
Zip	:	60556-9861
Country	:	US
Telephone Number	:	815-508-8327
Fax Number	:	815-264-3039

Authorized Official
Title or Position	:	CEO/SPEECH-LANGUAGE PATHOLOGIST
Name	:	ELIZABETH NIELSEN
Credential	:
Telephone Number	:	815-508-8327

Provider Enumeration Date	:	05/13/2015
Last Update Date	:	05/13/2015

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Directions to “TINY VOICE THERAPY SERVICES ” Practice Location

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