MEDICARE: PAMELA J. SMITH M.S., 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	SA1491	FL

General Provider Information

NPI Number	:	1023366390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA J. SMITH M.S., SLP

Provider Business Mailing Address
First Line	:	2336 PELICAN BAY CT
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7010
Country	:	US
Telephone Number	:	850-625-2931
Fax Number	:

Provider Business Practice Location Address
First Line	:	2336 PELICAN BAY CT
Second Line	:
City	:	PANAMA CITY BEACH
State	:	FL
Zip	:	32408-7010
Country	:	US
Telephone Number	:	850-625-2931
Fax Number	:

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

Provider Enumeration Date	:	08/17/2012
Last Update Date	:	08/17/2012

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