MEDICARE: JACQUELINE BELHAM MS CCC

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	3808	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP0196	OTHER	MA	PROVIDER NUMBER

General Provider Information

NPI Number	:	1225182041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE BELHAM MS CCC

Provider Business Mailing Address
First Line	:	80 DODGE AVE
Second Line	:
City	:	NORTH ATTLEBORO
State	:	MA
Zip	:	02760-4023
Country	:	US
Telephone Number	:	508-643-0964
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 DODGE AVE
Second Line	:
City	:	NORTH ATTLEBORO
State	:	MA
Zip	:	02760-4023
Country	:	US
Telephone Number	:	508-643-0964
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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