MEDICARE: MRS. SHARON GLICKKMAN MSCCCSLP

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	007084-1	NY

General Provider Information

NPI Number	:	1801108758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON GLICKKMAN MSCCCSLP

Provider Business Mailing Address
First Line	:	1164 E 8TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4702
Country	:	US
Telephone Number	:	718-258-8384
Fax Number	:

Provider Business Practice Location Address
First Line	:	1164 E 8TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11230-4702
Country	:	US
Telephone Number	:	718-258-8384
Fax Number	:

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

Provider Enumeration Date	:	07/08/2010
Last Update Date	:	07/08/2010

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