MEDICARE: MAGDALENE LIMA-FIALLOS MS, 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	SLP004115	GA

General Provider Information

NPI Number	:	1225097157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGDALENE LIMA-FIALLOS MS, CCC-SLP

Provider Business Mailing Address
First Line	:	2807 DUNAWAY DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-8738
Country	:	US
Telephone Number	:	229-446-0625
Fax Number	:	229-883-4484

Provider Business Practice Location Address
First Line	:	2807 DUNAWAY DR
Second Line	:
City	:	ALBANY
State	:	GA
Zip	:	31721-8738
Country	:	US
Telephone Number	:	229-446-0625
Fax Number	:	229-883-4484

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

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	07/08/2007

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Directions to “ MAGDALENE LIMA-FIALLOS MS, CCC-SLP” Practice Location

Language	Start Address	Practice Location

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