MEDICARE: MS. MAUREEN A ROESSLER M.S., 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	SLP4408	AZ

General Provider Information

NPI Number	:	1437343449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MAUREEN A ROESSLER M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	7039 N CLEAR SKY CT
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-9035
Country	:	US
Telephone Number	:	928-772-1691
Fax Number	:

Provider Business Practice Location Address
First Line	:	7039 N CLEAR SKY CT
Second Line	:
City	:	PRESCOTT VALLEY
State	:	AZ
Zip	:	86314-9035
Country	:	US
Telephone Number	:	928-772-1691
Fax Number	:

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

Provider Enumeration Date	:	09/03/2007
Last Update Date	:	09/03/2007

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