MEDICARE: MAUREEN C SURVANT SLP/CCC ED.D.

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	SA 3760	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	:	1457387961
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAUREEN C SURVANT SLP/CCC ED.D.

Provider Business Mailing Address
First Line	:	8317 FRONT BEACH RD
Second Line	:	SUITE 34 C
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-4885
Country	:	US
Telephone Number	:	850-233-3984
Fax Number	:	850-233-3954

Provider Business Practice Location Address
First Line	:	8317 FRONT BEACH RD
Second Line	:	SUITE 34 C
City	:	PANAMA CITY
State	:	FL
Zip	:	32407-4885
Country	:	US
Telephone Number	:	850-233-3984
Fax Number	:	850-233-3954

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

Provider Enumeration Date	:	06/25/2006
Last Update Date	:	07/08/2007

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Directions to “ MAUREEN C SURVANT SLP/CCC ED.D.” Practice Location

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