MEDICARE: MS. KRISTYSUE PERRINO 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	011656-1	NY

General Provider Information

NPI Number	:	1215181805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTYSUE PERRINO CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 737
Second Line	:
City	:	LAKE KATRINE
State	:	NY
Zip	:	12449-0737
Country	:	US
Telephone Number	:	845-247-0668
Fax Number	:

Provider Business Practice Location Address
First Line	:	41 CIDER MILL CT
Second Line	:
City	:	PLEASANT VALLEY
State	:	NY
Zip	:	12569-7387
Country	:	US
Telephone Number	:	845-638-3930
Fax Number	:

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

Provider Enumeration Date	:	11/09/2008
Last Update Date	:	11/09/2008

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