MEDICARE: MISS MICHELLE E BREEN MS 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	12003802

General Provider Information

NPI Number	:	1174797674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE E BREEN MS CCC-SLP

Provider Business Mailing Address
First Line	:	2490 JENNER CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3547
Country	:	US
Telephone Number	:	719-425-7771
Fax Number	:	303-223-0084

Provider Business Practice Location Address
First Line	:	2490 JENNER CT
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3547
Country	:	US
Telephone Number	:	719-425-7771
Fax Number	:	303-223-0084

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

Provider Enumeration Date	:	04/15/2008
Last Update Date	:	01/08/2013

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Directions to “ MISS MICHELLE E BREEN MS CCC-SLP” Practice Location

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