MEDICARE: LISA FARTHING 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 8799	FL

General Provider Information

NPI Number	:	1700021680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA FARTHING SLP

Provider Business Mailing Address
First Line	:	412 RIO VILLA BLVD
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3714
Country	:	US
Telephone Number	:	321-773-7218
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 RIO VILLA BLVD
Second Line	:
City	:	INDIALANTIC
State	:	FL
Zip	:	32903-3714
Country	:	US
Telephone Number	:	321-773-7218
Fax Number	:

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

Provider Enumeration Date	:	12/08/2008
Last Update Date	:	12/08/2008

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Directions to “ LISA FARTHING SLP” Practice Location

Language	Start Address	Practice Location

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