MEDICARE: MS. MARIA HELGESON SLP-CCC

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	SA5387	FL

General Provider Information

NPI Number	:	1477732162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIA HELGESON SLP-CCC

Provider Business Mailing Address
First Line	:	412 BONESET BRANCH LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-4400
Country	:	US
Telephone Number	:	904-287-2562
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 BONESET BRANCH LN
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32259-4400
Country	:	US
Telephone Number	:	904-287-2562
Fax Number	:

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

Provider Enumeration Date	:	10/30/2007
Last Update Date	:	10/30/2007

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