MEDICARE: MRS. CAROL MASELLI RUBACK 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	SA6684	FL

General Provider Information

NPI Number	:	1629220330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CAROL MASELLI RUBACK M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	1511 NW 99 AVENUE
Second Line	:	INNOVATIVE SPEECH & LANGUAGE SERVICES, P.A.
City	:	PLANTATION
State	:	FL
Zip	:	33322
Country	:	US
Telephone Number	:	954-253-4897
Fax Number	:	954-474-3403

Provider Business Practice Location Address
First Line	:	1511 NW 99 AVENUE
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33322
Country	:	US
Telephone Number	:	954-253-4897
Fax Number	:	954-474-3403

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

Provider Enumeration Date	:	10/14/2008
Last Update Date	:	10/14/2008

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Directions to “ MRS. CAROL MASELLI RUBACK M.S., CCC-SLP” Practice Location

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