MEDICARE: LAURIE ANN WELLS 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	SA10305	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	SA10305	OTHER	FL	DOH (FL)

General Provider Information

NPI Number	:	1780987271
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE ANN WELLS CCC-SLP

Provider Business Mailing Address
First Line	:	1985 FLASHY LN
Second Line	:	FL
City	:	MALABAR
State	:	FL
Zip	:	32950-3143
Country	:	US
Telephone Number	:	321-241-4816
Fax Number	:	321-241-4817

Provider Business Practice Location Address
First Line	:	2226 SARNO RD
Second Line	:	SUITE 101
City	:	MELBOURNE
State	:	FL
Zip	:	32935-3087
Country	:	US
Telephone Number	:	321-241-4816
Fax Number	:	321-241-4817

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

Provider Enumeration Date	:	12/06/2010
Last Update Date	:	01/16/2025

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