MEDICARE: BRONWYN RUTH BERAN M.S.

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	146010889	IL

General Provider Information

NPI Number	:	1912253873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRONWYN RUTH BERAN M.S.

Provider Business Mailing Address
First Line	:	1160 S MICHIGAN AVE
Second Line	:	UNIT 1005
City	:	CHICAGO
State	:	IL
Zip	:	60605-2776
Country	:	US
Telephone Number	:	608-921-9398
Fax Number	:

Provider Business Practice Location Address
First Line	:	1160 S MICHIGAN AVE
Second Line	:	UNIT 1005
City	:	CHICAGO
State	:	IL
Zip	:	60605-2776
Country	:	US
Telephone Number	:	608-921-9398
Fax Number	:

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

Provider Enumeration Date	:	07/30/2012
Last Update Date	:	07/30/2012

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