MEDICARE: MRS. AMY LYNN PEARSON 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	10199	FL

General Provider Information

NPI Number	:	1619104379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMY LYNN PEARSON CCC/SLP

Provider Business Mailing Address
First Line	:	1434 FOREST HILLS DR
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-3887
Country	:	US
Telephone Number	:	407-491-8308
Fax Number	:

Provider Business Practice Location Address
First Line	:	1060 W STATE ROAD 434 STE 108
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32750-4953
Country	:	US
Telephone Number	:	407-260-0551
Fax Number	:	407-265-9590

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

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	04/02/2012

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