MEDICARE: MS. MARIE ANN LAUTATO MS CCCSLP

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	013511-1	NY

General Provider Information

NPI Number	:	1790925899
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIE ANN LAUTATO MS CCCSLP

Provider Business Mailing Address
First Line	:	1154 72ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1306
Country	:	US
Telephone Number	:	917-559-7005
Fax Number	:

Provider Business Practice Location Address
First Line	:	1154 72ND ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11228-1306
Country	:	US
Telephone Number	:	917-559-7005
Fax Number	:

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

Provider Enumeration Date	:	03/02/2009
Last Update Date	:	09/04/2010

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