MEDICARE: ELIZABETH OLIVETO MS 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	08106	MD

General Provider Information

NPI Number	:	1013539352
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH OLIVETO MS CCC-SLP

Provider Business Mailing Address
First Line	:	8203 TALL TREES CT
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6943
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1051 BRIGHTSEAT RD
Second Line	:
City	:	LANDOVER
State	:	MD
Zip	:	20785-3738
Country	:	US
Telephone Number	:	240-487-4400
Fax Number	:

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

Provider Enumeration Date	:	05/09/2020
Last Update Date	:	05/09/2020

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