MEDICARE: MRS. TEKELIA SLOAN 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	2279G1100X	General Care Registered Respiratory Therapist	005472	GA
2	235Z00000X	Speech-Language Pathologist	001414	GA

General Provider Information

NPI Number	:	1992944227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TEKELIA SLOAN SLP

Provider Business Mailing Address
First Line	:	128 FRANCES MEEKS WAY STE 9
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3984
Country	:	US
Telephone Number	:	912-727-2321
Fax Number	:

Provider Business Practice Location Address
First Line	:	128 FRANCES MEEKS WAY STE 9
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3984
Country	:	US
Telephone Number	:	912-727-2321
Fax Number	:

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

Provider Enumeration Date	:	02/10/2009
Last Update Date	:	02/10/2009

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