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NPI Code Detail

MEDICARE: DANIELLE EBAUGH CFY - SLP

MEDICARE: DANIELLE EBAUGH CFY - 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
1235Z00000XSpeech-Language PathologistSZ 4691FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093952715
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANIELLE EBAUGH CFY - SLP
Provider Business Mailing Address
First Line : 4202 OKEECHOBEE RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-5414
Country : US
Telephone Number : 772-462-6636
Fax Number : 772-462-6635
Provider Business Practice Location Address
First Line : 4202 OKEECHOBEE RD
Second Line :
City : FORT PIERCE
State : FL
Zip : 34947-5414
Country : US
Telephone Number : 772-462-6636
Fax Number : 772-462-6635
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/16/2009
Last Update Date : 01/16/2009

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