MEDICARE: MRS. DIANNE M. CREA-POWERS MSCCC-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	005750-1	NY

General Provider Information

NPI Number	:	1164707246
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANNE M. CREA-POWERS MSCCC-SLP

Provider Business Mailing Address
First Line	:	6917 W BERGEN RD
Second Line	:
City	:	BERGEN
State	:	NY
Zip	:	14416-9743
Country	:	US
Telephone Number	:	585-494-2220
Fax Number	:

Provider Business Practice Location Address
First Line	:	6917 W BERGEN RD
Second Line	:
City	:	BERGEN
State	:	NY
Zip	:	14416-9743
Country	:	US
Telephone Number	:	585-494-2220
Fax Number	:

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

Provider Enumeration Date	:	10/20/2011
Last Update Date	:	11/18/2011

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Directions to “ MRS. DIANNE M. CREA-POWERS MSCCC-SLP” Practice Location

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