MEDICARE: NANCY POHLOT 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	6860	CA

General Provider Information

NPI Number	:	1386711075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY POHLOT M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	26851 VIA GRANDE
Second Line	:
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6134
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23361 MADERO
Second Line	:	SUITE 150
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-2715
Country	:	US
Telephone Number	:	949-581-8239
Fax Number	:	949-859-0928

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

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	07/08/2007

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