MEDICARE: MRS. BETH K MANNARINO MS CCCSLP

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	SA6922	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S2758	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801946983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BETH K MANNARINO MS CCCSLP

Provider Business Mailing Address
First Line	:	4443 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6198
Country	:	US
Telephone Number	:	727-846-9900
Fax Number	:

Provider Business Practice Location Address
First Line	:	4443 ROWAN RD
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34653-6198
Country	:	US
Telephone Number	:	727-846-9900
Fax Number	:

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

Provider Enumeration Date	:	01/11/2007
Last Update Date	:	09/26/2016

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