MEDICARE: ERICA MULLEN SCAMMACCA M.S.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	SA9440	FL

General Provider Information

NPI Number	:	1811290984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA MULLEN SCAMMACCA M.S.CCC-SLP

Provider Business Mailing Address
First Line	:	8396 ODIS YARBOROUGH RD
Second Line	:
City	:	GLEN SAINT MARY
State	:	FL
Zip	:	32040-2757
Country	:	US
Telephone Number	:	904-653-1991
Fax Number	:

Provider Business Practice Location Address
First Line	:	8396 ODIS YARBOROUGH RD
Second Line	:
City	:	GLEN SAINT MARY
State	:	FL
Zip	:	32040-2757
Country	:	US
Telephone Number	:	904-653-1991
Fax Number	:

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

Provider Enumeration Date	:	12/13/2010
Last Update Date	:	12/13/2010

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