MEDICARE: INGRAM CLAUDETTE LAND DEANS MA/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	5228	NC

General Provider Information

NPI Number	:	1750671731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	INGRAM CLAUDETTE LAND DEANS MA/CCC-SLP

Provider Business Mailing Address
First Line	:	930 EASTERN AVE
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1716
Country	:	US
Telephone Number	:	252-451-2895
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 EASTERN AVE
Second Line	:
City	:	NASHVILLE
State	:	NC
Zip	:	27856-1716
Country	:	US
Telephone Number	:	252-451-2895
Fax Number	:

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

Provider Enumeration Date	:	04/12/2011
Last Update Date	:	08/20/2013

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