MEDICARE: PHOEBE TUCKER 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	001487	CT

General Provider Information

NPI Number	:	1851668370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PHOEBE TUCKER SLP

Provider Business Mailing Address
First Line	:	2326 E MAIN ST
Second Line	:	MONTANO ASSISTIVE TECHNOLOGY CENTER
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-1801
Country	:	US
Telephone Number	:	203-269-3511
Fax Number	:	203-269-7411

Provider Business Practice Location Address
First Line	:	2326 E MAIN ST
Second Line	:	MONTANO ASSISTIVE TECHNOLOGY CENTER
City	:	BRIDGEPORT
State	:	CT
Zip	:	06610-1801
Country	:	US
Telephone Number	:	203-333-3366
Fax Number	:	203-333-3364

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

Provider Enumeration Date	:	11/29/2011
Last Update Date	:	11/29/2011

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Directions to “ PHOEBE TUCKER SLP” Practice Location

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