MEDICARE: MARNIE MAE REBECCA POMEROY 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	17538	CO

General Provider Information

NPI Number	:	1659799294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARNIE MAE REBECCA POMEROY M.S.CCC-SLP

Provider Business Mailing Address
First Line	:	6208 LA PLATA PEAK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3449
Country	:	US
Telephone Number	:	719-433-2299
Fax Number	:

Provider Business Practice Location Address
First Line	:	6208 LA PLATA PEAK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-3449
Country	:	US
Telephone Number	:	719-433-2299
Fax Number	:

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

Provider Enumeration Date	:	04/01/2014
Last Update Date	:	04/01/2014

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