MEDICARE: DEVYN A SQUIRES M.A., 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	SA17366	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366941312
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEVYN A SQUIRES M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	2271 SW DANFORTH CIRCLE
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 SW CAPRI ST
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-4518
Country	:	US
Telephone Number	:	772-220-1090
Fax Number	:

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

Provider Enumeration Date	:	02/06/2018
Last Update Date	:	01/19/2021

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Directions to “ DEVYN A SQUIRES M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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