MEDICARE: MRS. MIRANDA STAR WALKER M.A. 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	SP.10642	OH

General Provider Information

NPI Number	:	1023423878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MIRANDA STAR WALKER M.A. CCC-SLP

Provider Business Mailing Address
First Line	:	548 CRESTVIEW RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43202-2243
Country	:	US
Telephone Number	:	614-582-9927
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 MORSE RD
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43214-1833
Country	:	US
Telephone Number	:	614-468-8718
Fax Number	:

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

Provider Enumeration Date	:	06/30/2014
Last Update Date	:	06/30/2014

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Directions to “ MRS. MIRANDA STAR WALKER M.A. CCC-SLP” Practice Location

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