MEDICARE: TONI TURNER MCD 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	14896	TX
2	235Z00000X	Speech-Language Pathologist	SA6728	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	BCBS 87550T	OTHER	TX	SPEECH LANGUAGE PATHOLOGY

General Provider Information

NPI Number	:	1861507527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TONI TURNER MCD CCC SLP

Provider Business Mailing Address
First Line	:	14702 GRAYWOOD GROVE LN
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77062-2108
Country	:	US
Telephone Number	:	281-642-2700
Fax Number	:	281-535-1346

Provider Business Practice Location Address
First Line	:	3027 MARINA BAY DR
Second Line	:	#105
City	:	LEAGUE CITY
State	:	TX
Zip	:	77573-2729
Country	:	US
Telephone Number	:	281-642-2700
Fax Number	:	281-535-1346

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	07/08/2007

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