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NPI Code Detail

MEDICARE: KRISTEN MOSSIEN ECCLESTON CCC-SLP

MEDICARE: KRISTEN MOSSIEN ECCLESTON 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
1235Z00000XSpeech-Language Pathologist017663NY

General Provider Information

NPI Number : 1144522863
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN MOSSIEN ECCLESTON CCC-SLP
Provider Business Mailing Address
First Line : 15 WILLOWDALE DR
Second Line :
City : ROCHESTER
State : NY
Zip : 14618-2311
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 690 SAINT PAUL ST
Second Line :
City : ROCHESTER
State : NY
Zip : 14605-1709
Country : US
Telephone Number : 585-262-8257
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2010
Last Update Date : 10/23/2013

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Directions to “ KRISTEN MOSSIEN ECCLESTON CCC-SLP” Practice Location

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