MEDICARE: ABIGAIL BRIGHID COGHLAN M.S. 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	146.011718	IL

General Provider Information

NPI Number	:	1851651152
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABIGAIL BRIGHID COGHLAN M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	2923 N MILWAUKEE AVE
Second Line	:	UNIT 200
City	:	CHICAGO
State	:	IL
Zip	:	60618-7886
Country	:	US
Telephone Number	:	708-334-8411
Fax Number	:

Provider Business Practice Location Address
First Line	:	2923 N MILWAUKEE AVE
Second Line	:	UNIT 200
City	:	CHICAGO
State	:	IL
Zip	:	60618-7886
Country	:	US
Telephone Number	:	708-334-8411
Fax Number	:

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

Provider Enumeration Date	:	05/21/2012
Last Update Date	:	07/26/2014

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Directions to “ ABIGAIL BRIGHID COGHLAN M.S. CCC-SLP” Practice Location

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