MEDICARE: MRS. ALISON GRADY WALDMANN M.S. 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	003097	CT

General Provider Information

NPI Number	:	1467780213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALISON GRADY WALDMANN M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	19 MEADOW RIDGE LN
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-3740
Country	:	US
Telephone Number	:	860-350-4763
Fax Number	:

Provider Business Practice Location Address
First Line	:	19 MEADOW RIDGE LN
Second Line	:
City	:	NEW MILFORD
State	:	CT
Zip	:	06776-3740
Country	:	US
Telephone Number	:	860-350-4763
Fax Number	:

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

Provider Enumeration Date	:	12/04/2009
Last Update Date	:	08/17/2011

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