MEDICARE: JOANNA SCHWENKE

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	8047	MA

General Provider Information

NPI Number	:	1477999779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOANNA SCHWENKE

Provider Business Mailing Address
First Line	:	55 STRATHMORE RD
Second Line	:
City	:	BRIGHTON
State	:	MA
Zip	:	02135-7705
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2464 MASSACHUSETTS AVE
Second Line	:	450
City	:	NORTH CAMBRIDGE
State	:	MA
Zip	:	02140-1646
Country	:	US
Telephone Number	:	617-661-3171
Fax Number	:

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

Provider Enumeration Date	:	05/14/2013
Last Update Date	:	05/14/2013

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Directions to “ JOANNA SCHWENKE ” Practice Location

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