MEDICARE: TIS CHALLENGING SPEECH

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	261QR0401X	Comprehensive Outpatient Rehabilitation Facility (CORF)	686816	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	146589	OTHER	IL	MEDICARE OTHER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871569368
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIS CHALLENGING SPEECH

Provider Business Mailing Address
First Line	:	1706 SUPERIOR AVE
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-2424
Country	:	US
Telephone Number	:	815-541-1857
Fax Number	:	561-994-9240

Provider Business Practice Location Address
First Line	:	1706 SUPERIOR AVE
Second Line	:
City	:	SAVANNA
State	:	IL
Zip	:	61074-2424
Country	:	US
Telephone Number	:	815-541-1857
Fax Number	:	815-273-4354

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST ADMIN
Name	:	JEANNE RANE BYERS SPRAETZ
Credential	:	MA CCC SLP
Telephone Number	:	815-541-1857

Provider Enumeration Date	:	02/24/2006
Last Update Date	:	07/09/2008

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1790768620 — TOM M KAO DC PC
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Directions to “TIS CHALLENGING SPEECH ” Practice Location

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