MEDICARE: JUDY LYNN MCNABB MA/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

General Provider Information

NPI Number	:	1134423502
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDY LYNN MCNABB MA/CCC-SLP

Provider Business Mailing Address
First Line	:	539 GREEN SPRING CIR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3030
Country	:	US
Telephone Number	:	407-327-3442
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 GREEN SPRING CIR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3030
Country	:	US
Telephone Number	:	407-327-3442
Fax Number	:

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

Provider Enumeration Date	:	12/29/2010
Last Update Date	:	02/01/2012

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