MEDICARE: MRS. ILENE A ANCHELL

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	222Q00000X	Developmental Therapist	SA3407	FL
2	235Z00000X	Speech-Language Pathologist	SA3407	FL

General Provider Information

NPI Number	:	1083991269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ILENE A ANCHELL

Provider Business Mailing Address
First Line	:	9629 WATERVIEW WAY
Second Line	:
City	:	PARKLAND
State	:	FL
Zip	:	33076-2898
Country	:	US
Telephone Number	:	954-647-9767
Fax Number	:

Provider Business Practice Location Address
First Line	:	9724 W SAMPLE RD
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33065-4004
Country	:	US
Telephone Number	:	954-647-9767
Fax Number	:

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

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	06/30/2020

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