MEDICARE: DEIRDRE NOONAN 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	022742	NY

General Provider Information

NPI Number	:	1841557048
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEIRDRE NOONAN MS CCC-SLP

Provider Business Mailing Address
First Line	:	1 FRANKLIN AVE APT 5B
Second Line	:
City	:	WHITE PLAINS
State	:	NY
Zip	:	10601-3809
Country	:	US
Telephone Number	:	201-232-6797
Fax Number	:

Provider Business Practice Location Address
First Line	:	5980 9TH ST BLDG 1259
Second Line	:
City	:	FT BELVOIR
State	:	VA
Zip	:	22060-5509
Country	:	US
Telephone Number	:	571-231-1210
Fax Number	:

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

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	05/04/2020

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