MEDICARE: MRS. ELLEN RAE MCCAFFERTY M.A. 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	SP4183	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306260203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN RAE MCCAFFERTY M.A. CCC/SLP

Provider Business Mailing Address
First Line	:	3663 W 155TH ST
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3007
Country	:	US
Telephone Number	:	216-544-2829
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 W CLIFTON BLVD
Second Line	:
City	:	LAKEWOOD
State	:	OH
Zip	:	44107-1008
Country	:	US
Telephone Number	:	216-227-5826
Fax Number	:

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

Provider Enumeration Date	:	02/12/2014
Last Update Date	:	02/12/2014

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