MEDICARE: MS. BETTY L BUNNELL 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	SA9577	FL

General Provider Information

NPI Number	:	1750539813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BETTY L BUNNELL CCC-SLP

Provider Business Mailing Address
First Line	:	1024 MAZARION PL
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-4273
Country	:	US
Telephone Number	:	727-494-7458
Fax Number	:

Provider Business Practice Location Address
First Line	:	1024 MAZARION PL
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-4273
Country	:	US
Telephone Number	:	727-494-7458
Fax Number	:

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

Provider Enumeration Date	:	09/03/2008
Last Update Date	:	08/05/2010

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Directions to “ MS. BETTY L BUNNELL CCC-SLP” Practice Location

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