MEDICARE: EAST PASCO SPEECH SERVICES

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	:	1144896507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EAST PASCO SPEECH SERVICES

Provider Business Mailing Address
First Line	:	12236 WOODLANDS CIR
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-8287
Country	:	US
Telephone Number	:	901-413-0495
Fax Number	:

Provider Business Practice Location Address
First Line	:	12236 WOODLANDS CIR
Second Line	:
City	:	DADE CITY
State	:	FL
Zip	:	33525-8287
Country	:	US
Telephone Number	:	901-413-0495
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MS. JESSICA MABRY
Credential	:	M.A.CCC-SLP CBIS
Telephone Number	:	901-413-0495

Provider Enumeration Date	:	05/27/2021
Last Update Date	:	05/27/2021

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Directions to “EAST PASCO SPEECH SERVICES ” Practice Location

Language	Start Address	Practice Location

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