MEDICARE: MRS. STACY ELAINE MCINTOSH M.S

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	SA2632	FL

General Provider Information

NPI Number	:	1992833610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STACY ELAINE MCINTOSH M.S

Provider Business Mailing Address
First Line	:	101 ALEGRIA WAY
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418
Country	:	US
Telephone Number	:	561-506-6400
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 ALEGRIA WAY
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-1722
Country	:	US
Telephone Number	:	561-506-6400
Fax Number	:

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. STACY ELAINE MCINTOSH M.S” Practice Location

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