MEDICARE: AUDIOLOGY AND SPEECH PATHOLOGY, INC

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	231H00000X	Audiologist		FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	T0938	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285637892
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AUDIOLOGY AND SPEECH PATHOLOGY, INC

Provider Business Mailing Address
First Line	:	3540 FOREST HILL BLVD
Second Line	:	STE 205
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5878
Country	:	US
Telephone Number	:	561-649-4006
Fax Number	:	561-969-6621

Provider Business Practice Location Address
First Line	:	3540 FOREST HILL BLVD
Second Line	:	STE 205
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5878
Country	:	US
Telephone Number	:	561-649-4006
Fax Number	:	561-969-6621

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MEL GRANT
Credential	:	AU.D.
Telephone Number	:	561-649-4006

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	04/29/2008

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