MEDICARE: EAST PASCO SPEECH SERVICES

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

General Provider Information

NPI Number	:	1144896507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST PASCO SPEECH SERVICES

Provider Business Mailing Address
First Line	:	12236 WOODLANDS CIR
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-8287
Country	:	US
Telephone Number	:	901-413-0495
Fax Number	:

Provider Business Practice Location Address
First Line	:	12236 WOODLANDS CIR
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-8287
Country	:	US
Telephone Number	:	901-413-0495
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. JESSICA MABRY
Credential	:	M.A.CCC-SLP CBIS
Telephone Number	:	901-413-0495

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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Directions to “EAST PASCO SPEECH SERVICES ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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