MEDICARE: HAMLIN SLP SERRCIVES LLC

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	010992	NY

General Provider Information

NPI Number	:	1154608206
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HAMLIN SLP SERRCIVES LLC

Provider Business Mailing Address
First Line	:	3711 AVENUE S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4838
Country	:	US
Telephone Number	:	718-376-0084
Fax Number	:

Provider Business Practice Location Address
First Line	:	3711 AVENUE S
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11234-4838
Country	:	US
Telephone Number	:	718-376-0084
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	ROSEMARIE HAMLIN
Credential	:
Telephone Number	:	917-817-4508

Provider Enumeration Date	:	11/03/2011
Last Update Date	:	11/03/2011

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