MEDICARE: MS. TIA L. DENNIS 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	SA 10410	FL

General Provider Information

NPI Number	:	1144530577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIA L. DENNIS M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	11285 SW 211TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-2211
Country	:	US
Telephone Number	:	786-293-3933
Fax Number	:	305-378-0078

Provider Business Practice Location Address
First Line	:	11285 SW 211TH ST
Second Line	:
City	:	CUTLER BAY
State	:	FL
Zip	:	33189-2211
Country	:	US
Telephone Number	:	786-293-3933
Fax Number	:	305-378-0078

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

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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Directions to “ MS. TIA L. DENNIS M.S. CCC-SLP” Practice Location

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