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NPI Code Detail

MEDICARE: MS. DORA ELIA MALDONADO SPEECH THERAPIST

MEDICARE: MS. DORA ELIA MALDONADO SPEECH THERAPIST
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
1235Z00000XSpeech-Language Pathologist22001182AIN

General Provider Information

NPI Number : 1417228172
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. DORA ELIA MALDONADO SPEECH THERAPIST
Provider Business Mailing Address
First Line : 7109 COLORADO AVE
Second Line :
City : HAMMOND
State : IN
Zip : 46323-2334
Country : US
Telephone Number : 219-803-7298
Fax Number :
Provider Business Practice Location Address
First Line : 8380 VIRGINIA ST
Second Line :
City : MERRILLVILLE
State : IN
Zip : 46410-6231
Country : US
Telephone Number : 219-769-9009
Fax Number : 219-755-4522
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/25/2012
Last Update Date : 01/25/2012

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Directions to “ MS. DORA ELIA MALDONADO SPEECH THERAPIST” Practice Location

Language Start Address Practice Location
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