MEDICARE: MR. LAWRENCE EARL GEIGER III MS, 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	SA6157	FL

General Provider Information

NPI Number	:	1497081285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LAWRENCE EARL GEIGER III MS, CCC-SLP

Provider Business Mailing Address
First Line	:	5524 52ND AVE N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-3765
Country	:	US
Telephone Number	:	727-642-2699
Fax Number	:	727-545-0949

Provider Business Practice Location Address
First Line	:	5524 52ND AVE N
Second Line	:
City	:	KENNETH CITY
State	:	FL
Zip	:	33709-3765
Country	:	US
Telephone Number	:	727-642-2699
Fax Number	:	727-545-0949

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

Provider Enumeration Date	:	10/28/2009
Last Update Date	:	10/28/2009

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