MEDICARE: MADELINE BERTRAM 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	146.017759	IL

General Provider Information

NPI Number	:	1902792872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE BERTRAM CCC-SLP

Provider Business Mailing Address
First Line	:	1212 N WELLS ST APT 1501
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-5971
Country	:	US
Telephone Number	:	712-574-5220
Fax Number	:

Provider Business Practice Location Address
First Line	:	1212 N WELLS ST APT 1501
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60610-5971
Country	:	US
Telephone Number	:	712-574-5220
Fax Number	:

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

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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Directions to “ MADELINE BERTRAM CCC-SLP” Practice Location

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