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NPI Code Detail

MEDICARE: KATHERINE CANONICO M.S., CCC-SLP, TSSLD

MEDICARE: KATHERINE CANONICO M.S., CCC-SLP, TSSLD
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
1235Z00000XSpeech-Language Pathologist020234-1NY

General Provider Information

NPI Number : 1003115791
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHERINE CANONICO M.S., CCC-SLP, TSSLD
Provider Business Mailing Address
First Line : 240 E 85TH ST APT 4B
Second Line :
City : NEW YORK
State : NY
Zip : 10028-3048
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 369 E 148TH ST
Second Line : LOWER LEVEL
City : BRONX
State : NY
Zip : 10455-4041
Country : US
Telephone Number : 718-769-2698
Fax Number : 718-769-2317
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2011
Last Update Date : 07/09/2013

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Directions to “ KATHERINE CANONICO M.S., CCC-SLP, TSSLD” Practice Location

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