MEDICARE: MARGARET ELIZABETH TRUMAN 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	7101005083	MI

General Provider Information

NPI Number	:	1376055475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGARET ELIZABETH TRUMAN CCC-SLP

Provider Business Mailing Address
First Line	:	2847 ELMWOOD DR SE
Second Line	:
City	:	EAST GRAND RAPIDS
State	:	MI
Zip	:	49506-4204
Country	:	US
Telephone Number	:	414-323-0992
Fax Number	:

Provider Business Practice Location Address
First Line	:	2847 ELMWOOD DR SE
Second Line	:
City	:	EAST GRAND RAPIDS
State	:	MI
Zip	:	49506-4204
Country	:	US
Telephone Number	:	414-323-0992
Fax Number	:

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

Provider Enumeration Date	:	10/30/2017
Last Update Date	:	10/30/2017

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