MEDICARE: MR. BRYAN J RANDALL JR. M.S., 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	SL009234	PA

General Provider Information

NPI Number	:	1811158322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRYAN J RANDALL JR. M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	9800B MCKNIGHT RD
Second Line	:	SUITE 228
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-6020
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9800B MCKNIGHT RD
Second Line	:	SUITE 228
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-6020
Country	:	US
Telephone Number	:	412-364-2446
Fax Number	:

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

Provider Enumeration Date	:	06/18/2008
Last Update Date	:	06/18/2008

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Directions to “ MR. BRYAN J RANDALL JR. M.S., CCC-SLP” Practice Location

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