MEDICARE: MRS. MEAGHAN BENJAMIN MA 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	146007918	IL

General Provider Information

NPI Number	:	1902004369
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEAGHAN BENJAMIN MA CCC-SLP

Provider Business Mailing Address
First Line	:	2114 W SHAKESPEARE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3316
Country	:	US
Telephone Number	:	773-504-7119
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 W SHAKESPEARE AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60647-3316
Country	:	US
Telephone Number	:	773-504-7119
Fax Number	:

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

Provider Enumeration Date	:	07/06/2007
Last Update Date	:	06/27/2011

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