MEDICARE: MISS GIULIANA BUSALACCHI 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
1	235Z00000X	Speech-Language Pathologist	7101004855	MI

General Provider Information

NPI Number	:	1962909861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GIULIANA BUSALACCHI CCC-SLP

Provider Business Mailing Address
First Line	:	1363 E FISHER FWY APT 7
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-2615
Country	:	US
Telephone Number	:	313-580-1049
Fax Number	:

Provider Business Practice Location Address
First Line	:	8045 E JEFFERSON AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48214-2627
Country	:	US
Telephone Number	:	313-821-3525
Fax Number	:

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

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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Directions to “ MISS GIULIANA BUSALACCHI CCC-SLP” Practice Location

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