MEDICARE: MRS. DIANA ELAINE GODLEWSKI 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	2202002978	VA

General Provider Information

NPI Number	:	1104344118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANA ELAINE GODLEWSKI M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	100 MOUNT CLINTON PIKE
Second Line	:	ROCKINGHAM COUNTY SCHOOLS
City	:	HARRISONBURG
State	:	VA
Zip	:	22802
Country	:	US
Telephone Number	:	540-564-3221
Fax Number	:	540-564-3250

Provider Business Practice Location Address
First Line	:	100 MOUNT CLINTON PIKE
Second Line	:	ROCKINGHAM COUNTY SCHOOLS
City	:	HARRISBURG
State	:	VA
Zip	:	22802
Country	:	US
Telephone Number	:	540-564-3221
Fax Number	:	540-564-3250

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

Provider Enumeration Date	:	08/30/2017
Last Update Date	:	08/30/2017

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