MEDICARE: MRS. REBECCA GARDNER 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	SP10180	OH

General Provider Information

NPI Number	:	1427469527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. REBECCA GARDNER SLP

Provider Business Mailing Address
First Line	:	3607 SHANNON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44118-1928
Country	:	US
Telephone Number	:	216-926-9036
Fax Number	:

Provider Business Practice Location Address
First Line	:	3607 SHANNON RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44118-1928
Country	:	US
Telephone Number	:	216-926-9036
Fax Number	:

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

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	10/28/2014

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