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NPI Code Detail

MEDICARE: MR. DEVAN MEADE DECICCO M.A., CCC-SLP

MEDICARE: MR. DEVAN MEADE DECICCO M.A., 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
1235Z00000XSpeech-Language Pathologist021925-1NY

General Provider Information

NPI Number : 1669732046
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DEVAN MEADE DECICCO M.A., CCC-SLP
Provider Business Mailing Address
First Line : 434 BUGBEE DR
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-4204
Country : US
Telephone Number : 315-956-9773
Fax Number :
Provider Business Practice Location Address
First Line : 1351 WASHINGTON ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-4531
Country : US
Telephone Number : 315-785-3700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2012
Last Update Date : 07/17/2019

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Directions to “ MR. DEVAN MEADE DECICCO M.A., CCC-SLP” Practice Location

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