MEDICARE: MRS. ELLEN L. WEINBAUM 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	111656	MO

General Provider Information

NPI Number	:	1699924852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN L. WEINBAUM CCC/SLP

Provider Business Mailing Address
First Line	:	PO BOX 506
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-0506
Country	:	US
Telephone Number	:	573-265-0436
Fax Number	:

Provider Business Practice Location Address
First Line	:	17599 HIGHWAY 8
Second Line	:
City	:	SAINT JAMES
State	:	MO
Zip	:	65559-8227
Country	:	US
Telephone Number	:	573-265-0436
Fax Number	:

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

Provider Enumeration Date	:	09/12/2008
Last Update Date	:	09/12/2008

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