MEDICARE: ELIZABETH DIANN CHEEK M. ED. 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	SLP007489	GA
2	235Z00000X	Speech-Language Pathologist	SA 11246	FL

General Provider Information

NPI Number	:	1346515392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH DIANN CHEEK M. ED. CCC-SLP

Provider Business Mailing Address
First Line	:	80 BEACH DR W
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-4113
Country	:	US
Telephone Number	:	478-230-7069
Fax Number	:

Provider Business Practice Location Address
First Line	:	80 BEACH DR W
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-4113
Country	:	US
Telephone Number	:	478-230-7069
Fax Number	:

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

Provider Enumeration Date	:	03/08/2012
Last Update Date	:	03/08/2012

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Directions to “ ELIZABETH DIANN CHEEK M. ED. CCC-SLP” Practice Location

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