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NPI Code Detail

MEDICARE: MRS. DEBORAH MANNELLO MS CCC SLP

MEDICARE:  MRS. DEBORAH  MANNELLO  MS 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
1235Z00000XSpeech-Language Pathologist001052NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1M12121OTHERPIN BLUE CROSS BLUE SHIEL

General Provider Information

NPI Number : 1528043411
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DEBORAH MANNELLO MS CCC SLP
Provider Business Mailing Address
First Line : PO BOX 3568
Second Line :
City : KINGSTON
State : NY
Zip : 12402-3568
Country : US
Telephone Number : 845-331-2568
Fax Number :
Provider Business Practice Location Address
First Line : 211 HURLEY AVENUVE
Second Line : SUITE 1
City : KINGSTON
State : NY
Zip : 12401-2400
Country : US
Telephone Number : 845-331-2568
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/13/2005
Last Update Date : 07/08/2007

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Directions to “ MRS. DEBORAH MANNELLO MS CCC SLP” Practice Location

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