MEDICARE: MR. FRANK EDWARD NUTT III MS 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	022942-1	NY
2	252Y00000X	Early Intervention Provider Agency	022942-1	NY

General Provider Information

NPI Number	:	1770924201
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FRANK EDWARD NUTT III MS CCC/SLP

Provider Business Mailing Address
First Line	:	35 TWIN OAKS DR.
Second Line	:
City	:	CAMPBELL HALL
State	:	NY
Zip	:	10916-2107
Country	:	US
Telephone Number	:	845-728-1623
Fax Number	:

Provider Business Practice Location Address
First Line	:	35 TWIN OAKS DR.
Second Line	:
City	:	CAMPBELL HALL
State	:	NY
Zip	:	10916-2107
Country	:	US
Telephone Number	:	845-728-1623
Fax Number	:	845-651-1129

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

Provider Enumeration Date	:	07/12/2013
Last Update Date	:	03/18/2020

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