MEDICARE: MARY TRABUE FITZGERALD CCC-SLP, CCC-A

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	231H00000X	Audiologist	55	TN
2	235Z00000X	Speech-Language Pathologist	291	TN

General Provider Information

NPI Number	:	1215908058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY TRABUE FITZGERALD CCC-SLP, CCC-A

Provider Business Mailing Address
First Line	:	3704 SYCAMORE LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-1914
Country	:	US
Telephone Number	:	615-292-4741
Fax Number	:	615-385-2785

Provider Business Practice Location Address
First Line	:	3704 SYCAMORE LN
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37215-1914
Country	:	US
Telephone Number	:	615-292-4741
Fax Number	:	615-385-2785

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	09/11/2025

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