MEDICARE: CARI WELLS 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	SLP5823	AZ
2	235Z00000X	Speech-Language Pathologist	4104	KY

General Provider Information

NPI Number	:	1780827006
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARI WELLS MS CCC SLP

Provider Business Mailing Address
First Line	:	5426 E GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2826
Country	:	US
Telephone Number	:	602-758-3932
Fax Number	:

Provider Business Practice Location Address
First Line	:	5426 E GALBRAITH RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45236-2826
Country	:	US
Telephone Number	:	602-758-3932
Fax Number	:

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

Provider Enumeration Date	:	04/16/2009
Last Update Date	:	11/20/2012

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Directions to “ CARI WELLS MS CCC SLP” Practice Location

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