MEDICARE: GEORGE KLUG MA, 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	504	AK
2	235Z00000X	Speech-Language Pathologist	SP4088	TN
3	235Z00000X	Speech-Language Pathologist	SA 329	FL

General Provider Information

NPI Number	:	1174918841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE KLUG MA, SLP

Provider Business Mailing Address
First Line	:	5004 THOMAS DR.
Second Line	:	UNIT 1808
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408
Country	:	US
Telephone Number	:	907-602-8719
Fax Number	:

Provider Business Practice Location Address
First Line	:	5004 THOMAS DR
Second Line	:	UNIT 1808
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-6969
Country	:	US
Telephone Number	:	907-602-8719
Fax Number	:

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

Provider Enumeration Date	:	03/31/2015
Last Update Date	:	03/31/2015

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Directions to “ GEORGE KLUG MA, SLP” Practice Location

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