MEDICARE: MS. MIRIAM E DOMROESE OWENS 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	22000071	IN

General Provider Information

NPI Number	:	1154530632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MIRIAM E DOMROESE OWENS SLP

Provider Business Mailing Address
First Line	:	1412 MIAMI CT S
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2134
Country	:	US
Telephone Number	:	317-839-3564
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 MIAMI CT S
Second Line	:
City	:	PLAINFIELD
State	:	IN
Zip	:	46168-2134
Country	:	US
Telephone Number	:	317-839-3564
Fax Number	:

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	09/09/2011

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