MEDICARE: LAURA A PESCATORE 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	17401	FL

General Provider Information

NPI Number	:	1477166247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA A PESCATORE M.S.,CCC-SLP

Provider Business Mailing Address
First Line	:	3530 1ST AVE N STE 120
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-8441
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 1ST AVE N STE 120
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33713-8441
Country	:	US
Telephone Number	:	877-268-4329
Fax Number	:

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

Provider Enumeration Date	:	08/31/2020
Last Update Date	:	08/31/2020

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