MEDICARE: LAURA BETH SEIVERD MS 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	SA 5298	FL

General Provider Information

NPI Number	:	1891831210
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BETH SEIVERD MS CCC SLP

Provider Business Mailing Address
First Line	:	2839 LAKE SAXON DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-6620
Country	:	US
Telephone Number	:	813-760-3730
Fax Number	:	813-235-6207

Provider Business Practice Location Address
First Line	:	2839 LAKE SAXON DR
Second Line	:
City	:	LAND O LAKES
State	:	FL
Zip	:	34639-6620
Country	:	US
Telephone Number	:	813-760-3730
Fax Number	:	813-235-6207

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

Provider Enumeration Date	:	01/30/2007
Last Update Date	:	01/25/2008

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