MEDICARE: CARA ANNE IMBALZANO 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
1	235Z00000X	Speech-Language Pathologist	SL015955	PA

General Provider Information

NPI Number	:	1588322333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARA ANNE IMBALZANO MS, CCC-SLP

Provider Business Mailing Address
First Line	:	120 WELLINGTON DR
Second Line	:
City	:	ROARING BROOK TWP
State	:	PA
Zip	:	18444-9552
Country	:	US
Telephone Number	:	570-479-0831
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 WELLINGTON DR
Second Line	:
City	:	ROARING BROOK TWP
State	:	PA
Zip	:	18444-9552
Country	:	US
Telephone Number	:	570-479-0831
Fax Number	:

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

Provider Enumeration Date	:	11/29/2021
Last Update Date	:	11/29/2021

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