MEDICARE: MRS. ELLEN MARIE WARD 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	SA7882	FL

General Provider Information

NPI Number	:	1396936639
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN MARIE WARD M.S. CCC-SLP

Provider Business Mailing Address
First Line	:	7733 FORSYTH BLVD
Second Line	:	SUITE 2300
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-1817
Country	:	US
Telephone Number	:	800-677-1202
Fax Number	:	314-863-5378

Provider Business Practice Location Address
First Line	:	6919 PARKWAY BLVD
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-2909
Country	:	US
Telephone Number	:	813-558-5000
Fax Number	:

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

Provider Enumeration Date	:	08/01/2007
Last Update Date	:	08/01/2007

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