MEDICARE: SPEECH LANGUAGE COMMUNICATION SPECIALISTS LLC

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	2355S0801X	Speech-Language Assistant
2	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1477940831
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH LANGUAGE COMMUNICATION SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	862 PARK LAKE CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-3908
Country	:	US
Telephone Number	:	407-717-6049
Fax Number	:

Provider Business Practice Location Address
First Line	:	862 PARK LAKE CT
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-3908
Country	:	US
Telephone Number	:	407-717-6049
Fax Number	:

Authorized Official
Title or Position	:	OWNER AND SPEECH-LANGUAGE PATHOLOGI
Name	:	SAMANTHA HINSON
Credential	:	CCC-SLP
Telephone Number	:	407-717-6049

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	04/22/2015

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