MEDICARE: LAURA ADAMS

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	SZ12592	FL

General Provider Information

NPI Number	:	1366320483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA ADAMS

Provider Business Mailing Address
First Line	:	12 PONTE VEDRA COLONY CIR UNIT 12
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32082-2793
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 TAVERNIER DR STE B
Second Line	:
City	:	PONTE VEDRA BEACH
State	:	FL
Zip	:	32081-1270
Country	:	US
Telephone Number	:	904-404-2345
Fax Number	:

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

Provider Enumeration Date	:	08/26/2025
Last Update Date	:	08/26/2025

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Directions to “ LAURA ADAMS ” Practice Location

Language	Start Address	Practice Location

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