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NPI Code Detail

MEDICARE: MARY SMITH M.S. CCC-SLP

MEDICARE: MARY SMITH M.S. 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
1235Z00000XSpeech-Language PathologistSA936FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265579288
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY SMITH M.S. CCC-SLP
Provider Business Mailing Address
First Line : 847 BERRYHILL CIR
Second Line :
City : FRUITLAND PARK
State : FL
Zip : 34731-5287
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 606 S 9TH ST
Second Line :
City : LEESBURG
State : FL
Zip : 34748-6320
Country : US
Telephone Number : 352-805-4404
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 02/03/2023

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