MEDICARE: MARY FRANCES WALTZ M.A., CCC

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.2799	OH

General Provider Information

NPI Number	:	1659750404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY FRANCES WALTZ M.A., CCC

Provider Business Mailing Address
First Line	:	8350 COLONIAL MILL MNR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2763
Country	:	US
Telephone Number	:	513-678-5518
Fax Number	:

Provider Business Practice Location Address
First Line	:	8350 COLONIAL MILL MNR
Second Line	:
City	:	WEST CHESTER
State	:	OH
Zip	:	45069-2763
Country	:	US
Telephone Number	:	513-678-5518
Fax Number	:

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

Provider Enumeration Date	:	05/27/2015
Last Update Date	:	05/27/2015

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