MEDICARE: HETAL PATEL MA.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	7101000871	MI

General Provider Information

NPI Number	:	1457821910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HETAL PATEL MA.CCC-SLP

Provider Business Mailing Address
First Line	:	2384 MILLBROOK CT
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-3143
Country	:	US
Telephone Number	:	734-751-6456
Fax Number	:

Provider Business Practice Location Address
First Line	:	2384 MILLBROOK CT
Second Line	:
City	:	ROCHESTER HILLS
State	:	MI
Zip	:	48306-3143
Country	:	US
Telephone Number	:	734-751-6456
Fax Number	:

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

Provider Enumeration Date	:	11/27/2018
Last Update Date	:	11/27/2018

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Directions to “ HETAL PATEL MA.CCC-SLP” Practice Location

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