MEDICARE: MARIA JUDE SPERL M.S. 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	14077177	MN

General Provider Information

NPI Number	:	1194259655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA JUDE SPERL M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	867 JUNO AVE
Second Line	:	APARTMENT 2
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-3713
Country	:	US
Telephone Number	:	612-236-6183
Fax Number	:

Provider Business Practice Location Address
First Line	:	867 JUNO AVE
Second Line	:	APARTMENT 2
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-3713
Country	:	US
Telephone Number	:	612-236-6183
Fax Number	:

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

Provider Enumeration Date	:	04/11/2017
Last Update Date	:	04/11/2017

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Directions to “ MARIA JUDE SPERL M.S. CCC-SLP” Practice Location

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