MEDICARE: MRS. MARY LOU REARDON M.A., SLP/ 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 4257	OH

General Provider Information

NPI Number	:	1871902270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY LOU REARDON M.A., SLP/ CCC

Provider Business Mailing Address
First Line	:	6740 LOVELAND MIAMIVILLE RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-8795
Country	:	US
Telephone Number	:	513-697-3045
Fax Number	:	513-683-1584

Provider Business Practice Location Address
First Line	:	6740 LOVELAND MIAMIVILLE RD
Second Line	:
City	:	LOVELAND
State	:	OH
Zip	:	45140-8795
Country	:	US
Telephone Number	:	513-697-3045
Fax Number	:	513-683-1584

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

Provider Enumeration Date	:	08/11/2014
Last Update Date	:	08/11/2014

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