MEDICARE: MICHELLE ANN SMITH MS 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	SA3229	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538288980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE ANN SMITH MS CCC

Provider Business Mailing Address
First Line	:	4253 SW MUNCIE ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	33409-0000
Country	:	US
Telephone Number	:	772-871-2293
Fax Number	:

Provider Business Practice Location Address
First Line	:	213 S CONGRESS AVE
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3823
Country	:	US
Telephone Number	:	561-640-0013
Fax Number	:	561-471-1966

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

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/19/2008

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Directions to “ MICHELLE ANN SMITH MS CCC” Practice Location

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