MEDICARE: LINA A LENDRAITIS MS, CCC-SLPL

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	146.008203	IL

General Provider Information

NPI Number	:	1871666206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINA A LENDRAITIS MS, CCC-SLPL

Provider Business Mailing Address
First Line	:	824 WASHINGTON BLVD APT 2
Second Line	:
City	:	OAK PARK
State	:	IL
Zip	:	60302-4928
Country	:	US
Telephone Number	:	708-466-2211
Fax Number	:

Provider Business Practice Location Address
First Line	:	720 LAKE ST
Second Line	:	SUITE 201
City	:	OAK PARK
State	:	IL
Zip	:	60301-1424
Country	:	US
Telephone Number	:	708-466-2211
Fax Number	:

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

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	07/08/2007

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