MEDICARE: MS. ELLEN NOREEN FRIEDMAN MACCC 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	SP-2248	OH

General Provider Information

NPI Number	:	1417969502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELLEN NOREEN FRIEDMAN MACCC SLP

Provider Business Mailing Address
First Line	:	71 FALLS RIVER DR
Second Line	:
City	:	MUNROE FALLS
State	:	OH
Zip	:	44262-1800
Country	:	US
Telephone Number	:	330-928-7558
Fax Number	:

Provider Business Practice Location Address
First Line	:	71 FALLS RIVER DR
Second Line	:
City	:	MUNROE FALLS
State	:	OH
Zip	:	44262-1800
Country	:	US
Telephone Number	:	330-592-5253
Fax Number	:

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

Provider Enumeration Date	:	08/13/2006
Last Update Date	:	07/08/2007

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