MEDICARE: KELLY JANE NOLAND

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

General Provider Information

NPI Number	:	1841849841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY JANE NOLAND

Provider Business Mailing Address
First Line	:	6177 E 3500S RD
Second Line	:
City	:	SAINT ANNE
State	:	IL
Zip	:	60964-4049
Country	:	US
Telephone Number	:	815-422-5013
Fax Number	:

Provider Business Practice Location Address
First Line	:	6177 E 3500S RD
Second Line	:
City	:	SAINT ANNE
State	:	IL
Zip	:	60964-4049
Country	:	US
Telephone Number	:	815-422-5013
Fax Number	:

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

Provider Enumeration Date	:	09/11/2019
Last Update Date	:	09/11/2019

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Directions to “ KELLY JANE NOLAND ” Practice Location

Language	Start Address	Practice Location

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