MEDICARE: TERI LEE ZECHMAN

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	1041C0700X	Clinical Social Worker	SW2910	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

General Provider Information

NPI Number	:	1629637012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERI LEE ZECHMAN

Provider Business Mailing Address
First Line	:	459 GRACE AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2756
Country	:	US
Telephone Number	:	850-215-6007
Fax Number	:

Provider Business Practice Location Address
First Line	:	459 GRACE AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32401-2756
Country	:	US
Telephone Number	:	850-769-6001
Fax Number	:

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

Provider Enumeration Date	:	06/10/2019
Last Update Date	:	06/10/2019

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