MEDICARE: MICHELLE COFFARO M.S 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	11143	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083054167
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE COFFARO M.S CCC-SLP

Provider Business Mailing Address
First Line	:	5637 BLUEPINE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7450
Country	:	US
Telephone Number	:	513-205-3401
Fax Number	:

Provider Business Practice Location Address
First Line	:	5637 BLUEPINE DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45247-7450
Country	:	US
Telephone Number	:	513-205-3401
Fax Number	:

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

Provider Enumeration Date	:	07/03/2013
Last Update Date	:	09/04/2014

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