MEDICARE: MRS. JOAN MARGARET MONACO 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	840-154	WI

General Provider Information

NPI Number	:	1962604280
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN MARGARET MONACO M.S. CCC, SLP

Provider Business Mailing Address
First Line	:	3719 S 2ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-3826
Country	:	US
Telephone Number	:	414-744-5079
Fax Number	:

Provider Business Practice Location Address
First Line	:	3719 S 2ND ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53207-3826
Country	:	US
Telephone Number	:	414-744-5079
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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