MEDICARE: EMILY K SHAKRO 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	SLP 8545	AZ

General Provider Information

NPI Number	:	1942431382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY K SHAKRO CCC-SLP

Provider Business Mailing Address
First Line	:	101 S PLAYERS CLUB DR
Second Line	:	APT 25204
City	:	TUCSON
State	:	AZ
Zip	:	85745-5135
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 S PLAYERS CLUB DR
Second Line	:	APT 25204
City	:	TUCSON
State	:	AZ
Zip	:	85745-5135
Country	:	US
Telephone Number	:	630-306-1307
Fax Number	:

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

Provider Enumeration Date	:	08/03/2009
Last Update Date	:	01/25/2014

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Directions to “ EMILY K SHAKRO CCC-SLP” Practice Location

Language	Start Address	Practice Location

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