MEDICARE: MRS. ANNA WINGARD

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	5394	SC

General Provider Information

NPI Number	:	1407217029
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA WINGARD

Provider Business Mailing Address
First Line	:	2480 MINERAL SPRINGS RD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-9211
Country	:	US
Telephone Number	:	803-361-6887
Fax Number	:

Provider Business Practice Location Address
First Line	:	2480 MINERAL SPRINGS RD
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-9211
Country	:	US
Telephone Number	:	803-361-6887
Fax Number	:

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

Provider Enumeration Date	:	03/09/2016
Last Update Date	:	03/09/2016

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Directions to “ MRS. ANNA WINGARD ” Practice Location

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