MEDICARE: KELLIE SZKATULSKI 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	019808-1	NY

General Provider Information

NPI Number	:	1144545757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLIE SZKATULSKI CCC-SLP

Provider Business Mailing Address
First Line	:	10646 APPLEWOOD RD
Second Line	:
City	:	NORTH COLLINS
State	:	NY
Zip	:	14111-9722
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10646 APPLEWOOD RD
Second Line	:
City	:	NORTH COLLINS
State	:	NY
Zip	:	14111-9722
Country	:	US
Telephone Number	:	716-353-0373
Fax Number	:

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

Provider Enumeration Date	:	04/07/2010
Last Update Date	:	08/17/2011

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