MEDICARE: MS. IRENE TERRERO SLP-CCC

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	SA8353	FL

General Provider Information

NPI Number	:	1346315751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. IRENE TERRERO SLP-CCC

Provider Business Mailing Address
First Line	:	3501 GEORGIA AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-1832
Country	:	US
Telephone Number	:	561-650-8058
Fax Number	:	561-650-8059

Provider Business Practice Location Address
First Line	:	3501 GEORGIA AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33405-1832
Country	:	US
Telephone Number	:	561-650-8058
Fax Number	:	561-650-8059

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

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	07/08/2007

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