MEDICARE: MICHAEL FERGUSON M.A., 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	SLP1001418	DC
2	235Z00000X	Speech-Language Pathologist	1834075	CA
3	235Z00000X	Speech-Language Pathologist	29324	CA

General Provider Information

NPI Number	:	1720792575
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL FERGUSON M.A., CCC-SLP

Provider Business Mailing Address
First Line	:	2649 N ARROYO DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6112
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2649 N ARROYO DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-6112
Country	:	US
Telephone Number	:	570-573-4397
Fax Number	:

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

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	01/06/2023

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Directions to “ MICHAEL FERGUSON M.A., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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