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NPI Code Detail

MEDICARE: MS. MARY JOSEPHINE TROMBETTA MS, CCC-SLP

MEDICARE: MS. MARY JOSEPHINE TROMBETTA 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
1235Z00000XSpeech-Language PathologistIL

General Provider Information

NPI Number : 1831305291
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY JOSEPHINE TROMBETTA MS, CCC-SLP
Provider Business Mailing Address
First Line : 10645 S CENTRAL PARK AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60655-3203
Country : US
Telephone Number : 773-230-1000
Fax Number :
Provider Business Practice Location Address
First Line : 305 CHERRY ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19106-1803
Country : US
Telephone Number : 800-974-6383
Fax Number : 800-974-4241
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/15/2007
Last Update Date : 07/08/2007

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