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General NPI Number Information
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NPI Number | 1720454234
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Entity Type | Individual
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Provider Name | MARIA PETRASKO
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Gender | Female
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Dates
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Enumeration Date | 08/19/2015
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Last Update Date | 08/19/2015
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Provider Practice Location Address
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Address Line | 560 W JACKSON ST
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City | PAINESVILLE
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State | OH
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Zip | 44077-3130
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Country | US
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Telephone | 440-392-5451
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Fax |
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Provider Business Mailing Address
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Address Line | 3200 PIMLICO BLVD
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City | STOW
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State | OH
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Zip | 44224-6204
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Country | US
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Telephone | 330-687-6898
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | COND.2016079-SP
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License Number State | OH
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