MEDICARE: AIMEE BIRD MS, 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	105123	TX

General Provider Information

NPI Number	:	1083195630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIMEE BIRD MS, CCC/SLP

Provider Business Mailing Address
First Line	:	4129 CARLA ST
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75965-2240
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 WESTWARD DR
Second Line	:
City	:	NACOGDOCHES
State	:	TX
Zip	:	75964-1232
Country	:	US
Telephone Number	:	936-569-2631
Fax Number	:

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

Provider Enumeration Date	:	08/22/2018
Last Update Date	:	08/22/2018

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