MEDICARE: JANET MARIE BALLARD JANET BALLARD, 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	SA9651	FL

General Provider Information

NPI Number	:	1588816979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANET MARIE BALLARD JANET BALLARD, SLP

Provider Business Mailing Address
First Line	:	542 DOGWOOD LN
Second Line	:
City	:	SUGARLOAF KEY
State	:	FL
Zip	:	33042-3511
Country	:	US
Telephone Number	:	410-903-1972
Fax Number	:

Provider Business Practice Location Address
First Line	:	5220 COLLEGE RD
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-4302
Country	:	US
Telephone Number	:	305-295-0265
Fax Number	:

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

Provider Enumeration Date	:	10/16/2008
Last Update Date	:	10/16/2008

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