MEDICARE: HELEN P UPSHAW 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	SLP001206	GA

General Provider Information

NPI Number	:	1538236252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HELEN P UPSHAW CCC-SLP

Provider Business Mailing Address
First Line	:	1282 COBBLEMILL WAY NW
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30152-2899
Country	:	US
Telephone Number	:	770-590-7977
Fax Number	:

Provider Business Practice Location Address
First Line	:	413 INDIAN HILLS TRL
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-4055
Country	:	US
Telephone Number	:	770-973-3466
Fax Number	:	770-977-1582

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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Directions to “ HELEN P UPSHAW CCC-SLP” Practice Location

Language	Start Address	Practice Location

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