MEDICARE: BAY AREA VOICE CARE

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	:	1629762752
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAY AREA VOICE CARE

Provider Business Mailing Address
First Line	:	42 S KEEBLE AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-3114
Country	:	US
Telephone Number	:	415-497-4141
Fax Number	:

Provider Business Practice Location Address
First Line	:	42 S KEEBLE AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95126-3114
Country	:	US
Telephone Number	:	415-497-4141
Fax Number	:

Authorized Official
Title or Position	:	SPEECH PATHOLOGIST
Name	:	NICOLE MARIETTE FULTON
Credential	:	CCC-SLP
Telephone Number	:	415-497-4141

Provider Enumeration Date	:	06/02/2023
Last Update Date	:	06/02/2023

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Directions to “BAY AREA VOICE CARE ” Practice Location

Language	Start Address	Practice Location

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