MEDICARE: MS. TESSA CARMELA EBERLE 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	SL014680	PA

General Provider Information

NPI Number	:	1174171821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TESSA CARMELA EBERLE CCC-SLP

Provider Business Mailing Address
First Line	:	190 WELLES ST STE 128
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4961
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 WELLES ST STE 128
Second Line	:
City	:	FORTY FORT
State	:	PA
Zip	:	18704-4961
Country	:	US
Telephone Number	:	570-714-6420
Fax Number	:

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

Provider Enumeration Date	:	08/27/2019
Last Update Date	:	08/27/2019

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