MEDICARE: MARY LEE NEUBECK M.ED., 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	2202006692	VA

General Provider Information

NPI Number	:	1720772114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LEE NEUBECK M.ED., CCC-SLP

Provider Business Mailing Address
First Line	:	2312 PLANTATION DR
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23454-2739
Country	:	US
Telephone Number	:	757-620-3724
Fax Number	:

Provider Business Practice Location Address
First Line	:	1630 DONNA DR STE 103
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-6188
Country	:	US
Telephone Number	:	757-647-9138
Fax Number	:

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

Provider Enumeration Date	:	06/07/2023
Last Update Date	:	06/07/2023

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