MEDICARE: MINDFUL SPEECH & SWALLOWING INC

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

General Provider Information

NPI Number	:	1568134716
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINDFUL SPEECH & SWALLOWING INC

Provider Business Mailing Address
First Line	:	1677 HIDDEN LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3912
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1677 HIDDEN LN
Second Line	:
City	:	LAKEWOOD
State	:	NJ
Zip	:	08701-3912
Country	:	US
Telephone Number	:	917-363-3980
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	CHANA ROSENBERG
Credential	:
Telephone Number	:	917-363-3980

Provider Enumeration Date	:	10/05/2021
Last Update Date	:	06/01/2023

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