MEDICARE: CLAIRE DENNE 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	SL000662L	PA

General Provider Information

NPI Number	:	1255678348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLAIRE DENNE SLP

Provider Business Mailing Address
First Line	:	1337 W 6TH ST
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16505-2503
Country	:	US
Telephone Number	:	814-456-6000
Fax Number	:	814-456-6060

Provider Business Practice Location Address
First Line	:	4472 BUFFALO RD
Second Line	:
City	:	ERIE
State	:	PA
Zip	:	16510-2228
Country	:	US
Telephone Number	:	814-464-0660
Fax Number	:	814-464-0663

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

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	02/28/2013

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Directions to “ CLAIRE DENNE SLP” Practice Location

Language	Start Address	Practice Location

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