MEDICARE: MISS RENEE MARIE CORCORAN MA 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	017589	NY

General Provider Information

NPI Number	:	1689860454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS RENEE MARIE CORCORAN MA CCC-SLP

Provider Business Mailing Address
First Line	:	5913 SHOREHAM DR
Second Line	:
City	:	LAKE VIEW
State	:	NY
Zip	:	14085-9793
Country	:	US
Telephone Number	:	716-627-4954
Fax Number	:

Provider Business Practice Location Address
First Line	:	5913 SHOREHAM DR
Second Line	:
City	:	LAKE VIEW
State	:	NY
Zip	:	14085-9793
Country	:	US
Telephone Number	:	716-627-4954
Fax Number	:

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

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	09/14/2007

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