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NPI Code Detail

MEDICARE: MR. JUSTIN M RAFFERTY CCC-SLP

MEDICARE: MR. JUSTIN M RAFFERTY 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
1235Z00000XSpeech-Language Pathologist12142355MD
2235Z00000XSpeech-Language Pathologist21210CA

General Provider Information

NPI Number : 1215443858
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JUSTIN M RAFFERTY CCC-SLP
Provider Business Mailing Address
First Line : 3021 E 7TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2836
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3020 E 15TH ST
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2305
Country : US
Telephone Number : 510-261-5613
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2017
Last Update Date : 12/19/2017

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Directions to “ MR. JUSTIN M RAFFERTY CCC-SLP” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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