MEDICARE: KAREN MARIE CALLOCKIO

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	12152440	MI

General Provider Information

NPI Number	:	1942578034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MARIE CALLOCKIO

Provider Business Mailing Address
First Line	:	2100 PARK RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4938
Country	:	US
Telephone Number	:	517-782-8888
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 PARK RD
Second Line	:
City	:	JACKSON
State	:	MI
Zip	:	49203-4938
Country	:	US
Telephone Number	:	517-782-8888
Fax Number	:

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

Provider Enumeration Date	:	12/05/2011
Last Update Date	:	12/06/2011

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Directions to “ KAREN MARIE CALLOCKIO ” Practice Location

Language	Start Address	Practice Location

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