MEDICARE: JOAN GARTIN MACCC/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	KY-1383	KY

General Provider Information

NPI Number	:	1912181561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOAN GARTIN MACCC/SLP

Provider Business Mailing Address
First Line	:	663 GINGERMILL LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	663 GINGERMILL LN
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-1917
Country	:	US
Telephone Number	:	859-533-0754
Fax Number	:	859-543-8263

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

Provider Enumeration Date	:	12/18/2007
Last Update Date	:	12/18/2007

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Directions to “ JOAN GARTIN MACCC/SLP” Practice Location

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