Provider Demographics
NPI:1114632049
Name:MASELLO, PATRICIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:MASELLO
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5420 BECKLEY RD # 255
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-5719
Mailing Address - Country:US
Mailing Address - Phone:269-380-7588
Mailing Address - Fax:269-294-0612
Practice Address - Street 1:91 MINGES RD N
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7909
Practice Address - Country:US
Practice Address - Phone:269-380-7588
Practice Address - Fax:269-294-0612
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI7101007341235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist