Healthcare Provider Details

I. General information

NPI: 1326248295
Provider Name (Legal Business Name): MONICA MEBANE M.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 03/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 NEW CASTLE RD
BUTLER PA
16001-1743
US

IV. Provider business mailing address

519 PARK AVE
CANONSBURG PA
15317-3772
US

V. Phone/Fax

Practice location:
  • Phone: 724-228-1010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL009255
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: