MEDICARE: SMART IMAGING

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

General Provider Information

NPI Number	:	1649941345
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SMART IMAGING

Provider Business Mailing Address
First Line	:	3586 NW DEER OAK DR
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3444
Country	:	US
Telephone Number	:	772-342-0102
Fax Number	:

Provider Business Practice Location Address
First Line	:	3586 NW DEER OAK DR
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3444
Country	:	US
Telephone Number	:	772-342-0102
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SUZANNE BALL
Credential	:	CCC-SLP
Telephone Number	:	772-342-0102

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2021

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Directions to “SMART IMAGING ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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