MEDICARE: MARY VEILLEUX 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	SA1397	FL

General Provider Information

NPI Number	:	1205135464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY VEILLEUX MS, CCC-SLP

Provider Business Mailing Address
First Line	:	1817 SW 21ST ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3526
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1817 SW 21ST ST
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33991-3526
Country	:	US
Telephone Number	:	239-313-1901
Fax Number	:

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

Provider Enumeration Date	:	03/26/2011
Last Update Date	:	03/26/2011

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