MEDICARE: MRS. DEANNA MARIE PLATZ 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	SA5485	FL

General Provider Information

NPI Number	:	1235400300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEANNA MARIE PLATZ MA CCC/SLP

Provider Business Mailing Address
First Line	:	2325 GORHAM AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33907-4229
Country	:	US
Telephone Number	:	239-277-1152
Fax Number	:

Provider Business Practice Location Address
First Line	:	3735 EVANS AVE
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33901-9302
Country	:	US
Telephone Number	:	239-939-0657
Fax Number	:

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

Provider Enumeration Date	:	01/22/2012
Last Update Date	:	01/22/2012

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