MEDICARE: MR. WARREN L CRESCENZO MA, 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	YS 00101800	NJ

General Provider Information

NPI Number	:	1073517413
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WARREN L CRESCENZO MA, CCC-SLP

Provider Business Mailing Address
First Line	:	1104 E PARK AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-3322
Country	:	US
Telephone Number	:	856-696-3043
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 E PARK AVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360-3322
Country	:	US
Telephone Number	:	856-696-3043
Fax Number	:

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	11/01/2010

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Directions to “ MR. WARREN L CRESCENZO MA, CCC-SLP” Practice Location

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