MEDICARE: MRS. MAUREEN J ANDERSON MS

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	001561	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001561	OTHER	NY	SPEECH AND LANGUAGE PATHOLOGIST

General Provider Information

NPI Number	:	1386978567
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN J ANDERSON MS

Provider Business Mailing Address
First Line	:	912 GLENCOVE RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13206-3038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	912 GLENCOVE RD
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13206-3038
Country	:	US
Telephone Number	:	315-463-0415
Fax Number	:

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

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	09/22/2009

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Directions to “ MRS. MAUREEN J ANDERSON MS” Practice Location

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