MEDICARE: MS. MELISSA BETH RADEN 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	009190-1	NY

General Provider Information

NPI Number	:	1366695421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELISSA BETH RADEN MS CCC SLP

Provider Business Mailing Address
First Line	:	PO BOX 2024
Second Line	:
City	:	SEAFORD
State	:	NY
Zip	:	11783-0769
Country	:	US
Telephone Number	:	516-313-7067
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 SHORE RD
Second Line	:	APT.5Y
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4755
Country	:	US
Telephone Number	:	516-313-7067
Fax Number	:

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

Provider Enumeration Date	:	11/02/2008
Last Update Date	:	11/02/2008

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