MEDICARE: KAREN VELLEMAN 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
1	235Z00000X	Speech-Language Pathologist	002682	CT

General Provider Information

NPI Number	:	1336216969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN VELLEMAN MA CCC-SLP

Provider Business Mailing Address
First Line	:	701 COTTAGE GROVE RD
Second Line	:	SUITE E130
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3059
Country	:	US
Telephone Number	:	860-286-0838
Fax Number	:	860-286-0109

Provider Business Practice Location Address
First Line	:	701 COTTAGE GROVE RD
Second Line	:	SUITE E130
City	:	BLOOMFIELD
State	:	CT
Zip	:	06002-3059
Country	:	US
Telephone Number	:	860-286-0838
Fax Number	:	860-286-0109

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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