MEDICARE: MS. PATRICIA LYNN WILSON-LAVIGNE 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
1	235Z00000X	Speech-Language Pathologist	SA4399	FL

General Provider Information

NPI Number	:	1346646676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PATRICIA LYNN WILSON-LAVIGNE M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	5807 RICHARD PL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-6011
Country	:	US
Telephone Number	:	941-302-4830
Fax Number	:

Provider Business Practice Location Address
First Line	:	5807 RICHARD PL
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34231-6011
Country	:	US
Telephone Number	:	941-302-4830
Fax Number	:

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

Provider Enumeration Date	:	11/13/2014
Last Update Date	:	11/13/2014

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