MEDICARE: MRS. CHARMAINE D HANLEY MA 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	SA8116	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	672202496	OTHER	FL	MEDWAIVER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	244	OTHER	FL	ATA
4	13500901	OTHER	FL	CITRUS HEALTHCARE

General Provider Information

NPI Number	:	1548292931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHARMAINE D HANLEY MA CCC SLP

Provider Business Mailing Address
First Line	:	3310 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-1974
Country	:	US
Telephone Number	:	863-802-6600
Fax Number	:	863-802-6639

Provider Business Practice Location Address
First Line	:	3310 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-1974
Country	:	US
Telephone Number	:	863-802-6600
Fax Number	:	863-802-6639

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

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	06/24/2013

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