MEDICARE: AMBER LOUISE RANKIN

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	SA7952	FL

General Provider Information

NPI Number	:	1538302526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMBER LOUISE RANKIN

Provider Business Mailing Address
First Line	:	5807 PALMETTO DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3220
Country	:	US
Telephone Number	:	772-460-0919
Fax Number	:	772-460-0505

Provider Business Practice Location Address
First Line	:	5807 PALMETTO DR
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34982-3220
Country	:	US
Telephone Number	:	772-460-0919
Fax Number	:	772-460-0505

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

Provider Enumeration Date	:	04/07/2009
Last Update Date	:	04/07/2009

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Directions to “ AMBER LOUISE RANKIN ” Practice Location

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