MEDICARE: KATHRYN ANN BERNARD MA, CCC-SLP L

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		IL

General Provider Information

NPI Number	:	1932116118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHRYN ANN BERNARD MA, CCC-SLP L

Provider Business Mailing Address
First Line	:	217 E CULLERTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1306
Country	:	US
Telephone Number	:	312-922-0820
Fax Number	:	312-922-0804

Provider Business Practice Location Address
First Line	:	217 E CULLERTON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60616-1306
Country	:	US
Telephone Number	:	312-922-0820
Fax Number	:	312-922-0804

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

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	07/08/2007

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Directions to “ KATHRYN ANN BERNARD MA, CCC-SLP L” Practice Location

Language	Start Address	Practice Location

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