MEDICARE: MRS. DIANE ELIZABETH BREDES-NIES SPEECH LANGUAGE PATH

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	003823-1	NY

General Provider Information

NPI Number	:	1558665927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE ELIZABETH BREDES-NIES SPEECH LANGUAGE PATH

Provider Business Mailing Address
First Line	:	145 MIDLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-4051
Country	:	US
Telephone Number	:	585-467-8816
Fax Number	:	585-366-5575

Provider Business Practice Location Address
First Line	:	145 MIDLAND AVE
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14621-4051
Country	:	US
Telephone Number	:	585-467-8816
Fax Number	:	585-366-5575

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

Provider Enumeration Date	:	12/29/2010
Last Update Date	:	12/29/2010

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Directions to “ MRS. DIANE ELIZABETH BREDES-NIES SPEECH LANGUAGE PATH” Practice Location

Language	Start Address	Practice Location

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