MEDICARE: MRS. MELINDA PETERS PETRICH MACCCSLP

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	SL007271	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497883235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELINDA PETERS PETRICH MACCCSLP

Provider Business Mailing Address
First Line	:	1358 CRAIGVIEW DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15243-1702
Country	:	US
Telephone Number	:	412-276-6865
Fax Number	:	412-276-6865

Provider Business Practice Location Address
First Line	:	3394 SAXONBURG BLVD
Second Line	:	SUITE 620
City	:	GLENSHAW
State	:	PA
Zip	:	15116-3168
Country	:	US
Telephone Number	:	412-767-5967
Fax Number	:	412-767-5960

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	12/11/2008

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