MEDICARE: MRS. TRICIA GINN MSP 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	2202003119	VA

General Provider Information

NPI Number	:	1851507917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TRICIA GINN MSP CCCSLP

Provider Business Mailing Address
First Line	:	11820 BLANDFIELD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-2425
Country	:	US
Telephone Number	:	804-641-4548
Fax Number	:

Provider Business Practice Location Address
First Line	:	11820 BLANDFIELD ST
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23233-2425
Country	:	US
Telephone Number	:	804-641-4548
Fax Number	:

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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