MEDICARE: LAURIE LYNNE POPE M.S. 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	10589	FL

General Provider Information

NPI Number	:	1003461385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE LYNNE POPE M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	1468 MARJORIE LN
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-7826
Country	:	US
Telephone Number	:	941-426-3717
Fax Number	:

Provider Business Practice Location Address
First Line	:	1468 MARJORIE LN
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-7826
Country	:	US
Telephone Number	:	941-426-3717
Fax Number	:

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

Provider Enumeration Date	:	08/05/2019
Last Update Date	:	08/05/2019

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Directions to “ LAURIE LYNNE POPE M.S. CCC-SLP” Practice Location

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