Provider Demographics
NPI:1508987876
Name:HARTZOG, MELODY ALTHEA (SLP-L)
Entity Type:Individual
Prefix:MS
First Name:MELODY
Middle Name:ALTHEA
Last Name:HARTZOG
Suffix:
Gender:F
Credentials:SLP-L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5611
Mailing Address - Street 2:
Mailing Address - City:RIVER FOREST
Mailing Address - State:IL
Mailing Address - Zip Code:60305-5611
Mailing Address - Country:US
Mailing Address - Phone:773-889-8035
Mailing Address - Fax:773-637-1976
Practice Address - Street 1:1233 S KARLOV AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-1213
Practice Address - Country:US
Practice Address - Phone:773-889-8035
Practice Address - Fax:773-637-1976
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.002044235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist