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NPI Code Detail

MEDICARE: MS. KIM ANNETTE DETTMAN MS CCC-SLP

MEDICARE: MS. KIM ANNETTE DETTMAN MS 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
1235Z00000XSpeech-Language PathologistSA2613FL

General Provider Information

NPI Number : 1386989291
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KIM ANNETTE DETTMAN MS CCC-SLP
Provider Business Mailing Address
First Line : 4922 CAMBRIDGE BLVD #201
Second Line :
City : PALM HARBOR
State : FL
Zip : 34685
Country : US
Telephone Number : 727-543-2738
Fax Number :
Provider Business Practice Location Address
First Line : 2600 HIGHLANDS BLVD N
Second Line :
City : PALM HARBOR
State : FL
Zip : 34684-2114
Country : US
Telephone Number : 727-785-5671
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2012
Last Update Date : 12/04/2012

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