MEDICARE: VOX COLLABORATIVE LLC

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

General Provider Information

NPI Number	:	1902421423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VOX COLLABORATIVE LLC

Provider Business Mailing Address
First Line	:	2753 N HAMPDEN CT APT 4A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2331
Country	:	US
Telephone Number	:	312-560-2735
Fax Number	:

Provider Business Practice Location Address
First Line	:	2753 N HAMPDEN CT APT 4A
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60614-2331
Country	:	US
Telephone Number	:	312-560-2735
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SLP
Name	:	NADINE PORTERA
Credential	:	M.S., CCC-SLP
Telephone Number	:	312-560-2735

Provider Enumeration Date	:	06/10/2020
Last Update Date	:	06/10/2020

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