MEDICARE: MS. HEIDI ANNALISA BOHNE M.S. ED 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	013964-1	NY

General Provider Information

NPI Number	:	1265677892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HEIDI ANNALISA BOHNE M.S. ED CCC-SLP

Provider Business Mailing Address
First Line	:	3424 STATE ROUTE 4
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-3513
Country	:	US
Telephone Number	:	518-435-5492
Fax Number	:

Provider Business Practice Location Address
First Line	:	3424 STATE ROUTE 4
Second Line	:
City	:	HUDSON FALLS
State	:	NY
Zip	:	12839-3513
Country	:	US
Telephone Number	:	518-435-5492
Fax Number	:

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

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	12/11/2008

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