MEDICARE: PATRICIA SUZANNE CARUSO 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	SP3049	OH

General Provider Information

NPI Number	:	1912035601
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICIA SUZANNE CARUSO SLP

Provider Business Mailing Address
First Line	:	10615 CALICO LN
Second Line	:
City	:	CHARDON
State	:	OH
Zip	:	44024-8716
Country	:	US
Telephone Number	:	440-285-7762
Fax Number	:

Provider Business Practice Location Address
First Line	:	14800 PRIVATE DR
Second Line	:
City	:	EAST CLEVELAND
State	:	OH
Zip	:	44112-3553
Country	:	US
Telephone Number	:	216-761-3376
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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