MEDICARE: SALLEEANN WYATT-HURST M.S. 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	242002509	IL
2	235Z00000X	Speech-Language Pathologist	SA15617	FL

General Provider Information

NPI Number	:	1336483346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLEEANN WYATT-HURST M.S. SLP

Provider Business Mailing Address
First Line	:	2806 MIRACLE PKWY
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-3700
Country	:	US
Telephone Number	:	630-908-0018
Fax Number	:

Provider Business Practice Location Address
First Line	:	2806 MIRACLE PKWY
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33914-3700
Country	:	US
Telephone Number	:	630-908-0018
Fax Number	:

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

Provider Enumeration Date	:	11/15/2012
Last Update Date	:	09/15/2022

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