MEDICARE: MAYA ESHEL M.A., CF-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	242-000701	IL

General Provider Information

NPI Number	:	1942456041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA ESHEL M.A., CF-SLP

Provider Business Mailing Address
First Line	:	2714 W JULIA CT
Second Line	:	APT. #2
City	:	CHICAGO
State	:	IL
Zip	:	60647-4013
Country	:	US
Telephone Number	:	512-569-5709
Fax Number	:

Provider Business Practice Location Address
First Line	:	2714 W JULIA CT
Second Line	:	APT. #2
City	:	CHICAGO
State	:	IL
Zip	:	60647-4013
Country	:	US
Telephone Number	:	512-569-5709
Fax Number	:

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

Provider Enumeration Date	:	08/08/2008
Last Update Date	:	08/08/2008

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