MEDICARE: PATRICIA MASELLO M.S., 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	7101007341	MI

General Provider Information

NPI Number	:	1114632049
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA MASELLO M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	5420 BECKLEY RD # 255
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-5719
Country	:	US
Telephone Number	:	269-380-7588
Fax Number	:	269-294-0612

Provider Business Practice Location Address
First Line	:	91 MINGES RD N
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49015-7909
Country	:	US
Telephone Number	:	269-380-7588
Fax Number	:	269-294-0612

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

Provider Enumeration Date	:	01/16/2023
Last Update Date	:	08/08/2023

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