MEDICARE: CELINA B ALDRICH M.A., CCC-SLP/L

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	12135068	NY

General Provider Information

NPI Number	:	1356590699
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CELINA B ALDRICH M.A., CCC-SLP/L

Provider Business Mailing Address
First Line	:	34 BUNKER HILL DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-1302
Country	:	US
Telephone Number	:	585-703-8579
Fax Number	:

Provider Business Practice Location Address
First Line	:	34 BUNKER HILL DR
Second Line	:
City	:	ROCHESTER
State	:	NY
Zip	:	14625-1302
Country	:	US
Telephone Number	:	585-703-8579
Fax Number	:

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

Provider Enumeration Date	:	09/11/2008
Last Update Date	:	09/01/2011

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