MEDICARE: JANICE L MESARIC 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	SL008160	PA

General Provider Information

NPI Number	:	1619284726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANICE L MESARIC M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	449 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3414
Country	:	US
Telephone Number	:	215-643-5585
Fax Number	:	215-643-5586

Provider Business Practice Location Address
First Line	:	449 PENNSYLVANIA AVE
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-3414
Country	:	US
Telephone Number	:	215-643-5585
Fax Number	:	215-643-5586

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

Provider Enumeration Date	:	09/10/2010
Last Update Date	:	09/10/2010

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Directions to “ JANICE L MESARIC M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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