MEDICARE: LEA MASON 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

General Provider Information

NPI Number	:	1538748579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEA MASON CCC-SLP

Provider Business Mailing Address
First Line	:	92 SWEETFERN CT
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3741
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3 EVES DR STE 308
Second Line	:
City	:	MARLTON
State	:	NJ
Zip	:	08053-3129
Country	:	US
Telephone Number	:	523-885-6334
Fax Number	:

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

Provider Enumeration Date	:	04/06/2021
Last Update Date	:	04/06/2021

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Directions to “ LEA MASON CCC-SLP” Practice Location

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