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NPI Code Detail

MEDICARE: PATRICIA MANSILLA MA, CCC-SLP

MEDICARE: PATRICIA MANSILLA MA, 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 Pathologist5923OH

General Provider Information

NPI Number : 1306261672
Entity Type Code : Individual
Provider Name (Legal Business Name) : PATRICIA MANSILLA MA, CCC-SLP
Provider Business Mailing Address
First Line : 1440 LAKESIDE AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-1137
Country : US
Telephone Number : 216-685-5110
Fax Number :
Provider Business Practice Location Address
First Line : 1440 LAKESIDE AVE E
Second Line :
City : CLEVELAND
State : OH
Zip : 44114-1137
Country : US
Telephone Number : 216-685-5110
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/24/2014
Last Update Date : 02/24/2014

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Directions to “ PATRICIA MANSILLA MA, CCC-SLP” Practice Location

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