MEDICARE: MISS TERESA TAYLOR AMMONS MS,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	4875	NC

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	:	1700816451
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS TERESA TAYLOR AMMONS MS,CCC-SLP

Provider Business Mailing Address
First Line	:	2932 BREEZEWOOD AVE
Second Line	:	SUITE 203
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5505
Country	:	US
Telephone Number	:	910-423-7234
Fax Number	:	910-423-8213

Provider Business Practice Location Address
First Line	:	2932 BREEZEWOOD AVE
Second Line	:	SUITE 203
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-5505
Country	:	US
Telephone Number	:	910-423-7234
Fax Number	:	910-423-8213

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	07/09/2007

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