=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346571247
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LUANE C MASON MA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/18/2010
-----------------------------------------------------
Last Update Date | 01/18/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1811 JUANITA CT
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33764-6619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-535-3424
-----------------------------------------------------
Fax | 727-216-3573
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1811 JUANITA CT
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33764-6619
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-535-3424
-----------------------------------------------------
Fax | 727-216-3573
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA674
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------