MEDICARE: MR. DANIEL BLANCHARD MS 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	018650-1	NY

General Provider Information

NPI Number	:	1336453851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DANIEL BLANCHARD MS CCC-SLP

Provider Business Mailing Address
First Line	:	401 W 47TH ST APT 11
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-2435
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 W 47TH ST APT 11
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10036-2435
Country	:	US
Telephone Number	:	413-218-9837
Fax Number	:

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

Provider Enumeration Date	:	07/27/2010
Last Update Date	:	07/27/2010

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Directions to “ MR. DANIEL BLANCHARD MS CCC-SLP” Practice Location

Language	Start Address	Practice Location

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