MEDICARE: ED REZNY MA, 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	SP.9773	OH

General Provider Information

NPI Number	:	1245639798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ED REZNY MA, CCC-SLP

Provider Business Mailing Address
First Line	:	35 BROOKLAWN CT
Second Line	:
City	:	HOWARD
State	:	OH
Zip	:	43028-9275
Country	:	US
Telephone Number	:	440-821-5443
Fax Number	:

Provider Business Practice Location Address
First Line	:	150 COLUMBUS RD
Second Line	:
City	:	MOUNT VERNON
State	:	OH
Zip	:	43050-4034
Country	:	US
Telephone Number	:	740-393-5975
Fax Number	:	740-393-5976

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

Provider Enumeration Date	:	08/21/2014
Last Update Date	:	08/21/2014

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Directions to “ ED REZNY MA, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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