MEDICARE: MRS. MORWENNA ELIZABETH BALDESSARI M.A., 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	16769	CA

General Provider Information

NPI Number	:	1134909757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MORWENNA ELIZABETH BALDESSARI M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	1264 GRAND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4274
Country	:	US
Telephone Number	:	732-616-0743
Fax Number	:

Provider Business Practice Location Address
First Line	:	1264 GRAND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4274
Country	:	US
Telephone Number	:	732-616-0743
Fax Number	:

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

Provider Enumeration Date	:	10/02/2023
Last Update Date	:	10/02/2023

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