MEDICARE: MRS. JAMIE MARIE GUADAGNINO MA 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	41YS00554300	NJ

General Provider Information

NPI Number	:	1346833456
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMIE MARIE GUADAGNINO MA SLP

Provider Business Mailing Address
First Line	:	1400 ROUTE 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5949
Country	:	US
Telephone Number	:	732-370-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 ROUTE 70
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-5949
Country	:	US
Telephone Number	:	732-370-0444
Fax Number	:

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

Provider Enumeration Date	:	02/19/2021
Last Update Date	:	02/19/2021

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Directions to “ MRS. JAMIE MARIE GUADAGNINO MA SLP” Practice Location

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