MEDICARE: JULIANNA FERGUSON MCD, CF-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	SZ8616	FL

General Provider Information

NPI Number	:	1023580289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIANNA FERGUSON MCD, CF-SLP

Provider Business Mailing Address
First Line	:	4712 W MELROSE AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5528
Country	:	US
Telephone Number	:	813-389-5983
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 31ST ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-4051
Country	:	US
Telephone Number	:	727-867-1104
Fax Number	:

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

Provider Enumeration Date	:	12/27/2018
Last Update Date	:	12/27/2018

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