MEDICARE: KRISTY J. GEORGE MEDCCC-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	SA4718	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1093961096
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTY J. GEORGE MEDCCC-SLP

Provider Business Mailing Address
First Line	:	5661 97TH WAY N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33708-3433
Country	:	US
Telephone Number	:	813-598-1513
Fax Number	:

Provider Business Practice Location Address
First Line	:	5661 97TH WAY N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33708-3433
Country	:	US
Telephone Number	:	813-598-1513
Fax Number	:

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

Provider Enumeration Date	:	08/11/2008
Last Update Date	:	08/11/2008

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