MEDICARE: MRS. AMANDA YABLUN M.A., 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	146.007107	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	146.007107	OTHER	IL	DEPT. OF PROF. RELATIONS

General Provider Information

NPI Number	:	1801015508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA YABLUN M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	3813 REDWOOD CT
Second Line	:
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-8623
Country	:	US
Telephone Number	:	815-342-7957
Fax Number	:

Provider Business Practice Location Address
First Line	:	3813 REDWOOD CT
Second Line	:
City	:	SPRING GROVE
State	:	IL
Zip	:	60081-8623
Country	:	US
Telephone Number	:	815-342-7957
Fax Number	:

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

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	05/18/2023

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