MEDICARE: MRS. MARY ELLEN CAMPOSANO MS, CCC-SLP, CAED

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	12089349	TX

General Provider Information

NPI Number	:	1134574759
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ELLEN CAMPOSANO MS, CCC-SLP, CAED

Provider Business Mailing Address
First Line	:	10017 CHEZELLE DR
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79925-5409
Country	:	US
Telephone Number	:	915-309-6576
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 N CAMPBELL ST
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79902-4238
Country	:	US
Telephone Number	:	915-747-8220
Fax Number	:

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

Provider Enumeration Date	:	05/02/2016
Last Update Date	:	05/02/2016

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Directions to “ MRS. MARY ELLEN CAMPOSANO MS, CCC-SLP, CAED” Practice Location

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