MEDICARE: MISS MARY OLIVIA GABRIELLE VIOLANTE MA 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		IL

General Provider Information

NPI Number	:	1992831333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MARY OLIVIA GABRIELLE VIOLANTE MA CCC SLP

Provider Business Mailing Address
First Line	:	1103 W BARRY AVE
Second Line	:	3W
City	:	CHICAGO
State	:	IL
Zip	:	60657-4375
Country	:	US
Telephone Number	:	630-743-1701
Fax Number	:

Provider Business Practice Location Address
First Line	:	1103 W BARRY AVE
Second Line	:	3W
City	:	CHICAGO
State	:	IL
Zip	:	60657-4375
Country	:	US
Telephone Number	:	630-743-1701
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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