Healthcare Provider Details

I. General information

NPI: 1831305291
Provider Name (Legal Business Name): MARY JOSEPHINE TROMBETTA MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 CHERRY ST
PHILADELPHIA PA
19106-1803
US

IV. Provider business mailing address

10645 S CENTRAL PARK AVE
CHICAGO IL
60655-3203
US

V. Phone/Fax

Practice location:
  • Phone: 800-974-6383
  • Fax: 800-974-4241
Mailing address:
  • Phone: 773-230-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: