MEDICARE: MS. JUNE MARIE FISH CCCSLP

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	6785	NC

General Provider Information

NPI Number	:	1457407645
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JUNE MARIE FISH CCCSLP

Provider Business Mailing Address
First Line	:	12547 MORNING CREEK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-1030
Country	:	US
Telephone Number	:	704-942-7278
Fax Number	:

Provider Business Practice Location Address
First Line	:	12547 MORNING CREEK LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28214-1030
Country	:	US
Telephone Number	:	704-942-7278
Fax Number	:

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

Provider Enumeration Date	:	01/28/2007
Last Update Date	:	07/08/2007

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