MEDICARE: MARIA C. LASALLE 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	SA 11620	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	:	1659636660
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIA C. LASALLE SLP

Provider Business Mailing Address
First Line	:	412 HARBOR WINDS CT
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-5700
Country	:	US
Telephone Number	:	407-325-7736
Fax Number	:

Provider Business Practice Location Address
First Line	:	7205 ALOMA AVE
Second Line	:
City	:	WINTER PARK
State	:	FL
Zip	:	32792-7101
Country	:	US
Telephone Number	:	321-972-3960
Fax Number	:	321-972-3960

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

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	03/17/2018

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Directions to “ MARIA C. LASALLE SLP” Practice Location

Language	Start Address	Practice Location

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