MEDICARE: MRS. GLORIA J. MANTINI LICENSED 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	SP-1591	OH

General Provider Information

NPI Number	:	1629104054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLORIA J. MANTINI LICENSED SLP

Provider Business Mailing Address
First Line	:	1909 N RIDGE RD E
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3379
Country	:	US
Telephone Number	:	440-277-7337
Fax Number	:	440-277-7339

Provider Business Practice Location Address
First Line	:	1909 N RIDGE RD E
Second Line	:
City	:	LORAIN
State	:	OH
Zip	:	44055-3379
Country	:	US
Telephone Number	:	440-277-7337
Fax Number	:	440-277-7339

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	04/02/2009

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