MEDICARE: MRS. AMY ANN CHOLIS

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	146009840	IL

General Provider Information

NPI Number	:	1891077517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY ANN CHOLIS

Provider Business Mailing Address
First Line	:	3736 N SHEFFIELD AVE APT 2N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5939
Country	:	US
Telephone Number	:	708-261-2453
Fax Number	:

Provider Business Practice Location Address
First Line	:	3736 N SHEFFIELD AVE APT 2N
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60613-5939
Country	:	US
Telephone Number	:	708-261-2453
Fax Number	:

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

Provider Enumeration Date	:	09/20/2011
Last Update Date	:	09/20/2011

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