Provider Demographics
NPI:1700193802
Name:MEDLEY & MESARIC THERAPY ASSICIATES, LLC
Entity Type:Organization
Organization Name:MEDLEY & MESARIC THERAPY ASSICIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:L
Authorized Official - Last Name:MESARIC
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:215-643-5585
Mailing Address - Street 1:449 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19034-3414
Mailing Address - Country:US
Mailing Address - Phone:215-643-5585
Mailing Address - Fax:
Practice Address - Street 1:449 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:19034-3414
Practice Address - Country:US
Practice Address - Phone:215-643-5585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-10
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL008160235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty