MEDICARE: AMY R COMMON 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	SP4271	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SP4271	OTHER	OH	OHIO BOARD OF SPEECH LANG

General Provider Information

NPI Number	:	1023008604
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY R COMMON SLP

Provider Business Mailing Address
First Line	:	533 E MAIN ST
Second Line	:
City	:	RAVENNA
State	:	OH
Zip	:	44266-3218
Country	:	US
Telephone Number	:	330-297-9020
Fax Number	:	330-297-9095

Provider Business Practice Location Address
First Line	:	6847 N CHESTNUT ST
Second Line	:	STE 100
City	:	RAVENNA
State	:	OH
Zip	:	44266-3929
Country	:	US
Telephone Number	:	330-297-2770
Fax Number	:	330-297-8833

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/08/2007

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Directions to “ AMY R COMMON SLP” Practice Location

Language	Start Address	Practice Location

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