MEDICARE: MRS. NANCY ROSE HANOVER 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	004651	NY

General Provider Information

NPI Number	:	1336424936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NANCY ROSE HANOVER CCC-SLP

Provider Business Mailing Address
First Line	:	1115 CAMPBELL BLVD.
Second Line	:	LEFT
City	:	BUFFALO
State	:	NY
Zip	:	14228
Country	:	US
Telephone Number	:	716-579-2547
Fax Number	:

Provider Business Practice Location Address
First Line	:	1115 CAMPBELL BLVD.
Second Line	:	LEFT
City	:	BUFFALO
State	:	NY
Zip	:	14228
Country	:	US
Telephone Number	:	716-579-2547
Fax Number	:

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

Provider Enumeration Date	:	10/14/2011
Last Update Date	:	01/08/2019

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