MEDICARE: BERNADETTE M. SMAIL 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	SA 14212	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

General Provider Information

NPI Number	:	1821322512
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNADETTE M. SMAIL SLP

Provider Business Mailing Address
First Line	:	11899 REMSEN RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-0730
Country	:	US
Telephone Number	:	703-887-7577
Fax Number	:

Provider Business Practice Location Address
First Line	:	3663 CROWN POINT CT
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-5967
Country	:	US
Telephone Number	:	904-288-8910
Fax Number	:

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

Provider Enumeration Date	:	09/28/2009
Last Update Date	:	07/21/2016

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Language	Start Address	Practice Location

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