MEDICARE: LAURA MAC 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	SZ3609	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750427092
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA MAC CCC-SLP

Provider Business Mailing Address
First Line	:	129 E BAY CEDAR CIR
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7105
Country	:	US
Telephone Number	:	561-670-4864
Fax Number	:	561-741-2925

Provider Business Practice Location Address
First Line	:	129 E BAY CEDAR CIR
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33458-7105
Country	:	US
Telephone Number	:	561-670-4864
Fax Number	:	561-741-2925

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	08/13/2009

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Directions to “ LAURA MAC CCC-SLP” Practice Location

Language	Start Address	Practice Location

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