MEDICARE: LAURA DENCH M.A., CCC

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	SA8439	FL

General Provider Information

NPI Number	:	1184760118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA DENCH M.A., CCC

Provider Business Mailing Address
First Line	:	16413 BRIDGELAWN AVE
Second Line	:
City	:	LITHIA
State	:	FL
Zip	:	33547-4849
Country	:	US
Telephone Number	:	813-436-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 S PARSONS AVE
Second Line	:
City	:	BRANDON
State	:	FL
Zip	:	33511-6063
Country	:	US
Telephone Number	:	813-436-5900
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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Directions to “ LAURA DENCH M.A., CCC” Practice Location

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