MEDICARE: MRS. MARGIE FAY ADDISON 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	SA8913	FL

General Provider Information

NPI Number	:	1497885842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARGIE FAY ADDISON M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	629 SW MORRIS STEEN RD
Second Line	:
City	:	GREENVILLE
State	:	FL
Zip	:	32331-3815
Country	:	US
Telephone Number	:	850-843-1052
Fax Number	:	850-948-3952

Provider Business Practice Location Address
First Line	:	214 N WASHINGTON ST
Second Line	:
City	:	PERRY
State	:	FL
Zip	:	32347-2744
Country	:	US
Telephone Number	:	850-843-1052
Fax Number	:	850-948-3952

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

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. MARGIE FAY ADDISON M.S., CCC-SLP” Practice Location

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