MEDICARE: IAN FARMER 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	2018016958	MO

General Provider Information

NPI Number	:	1932749447
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN FARMER MS CCC-SLP

Provider Business Mailing Address
First Line	:	1220 N 10TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-4636
Country	:	US
Telephone Number	:	314-231-0143
Fax Number	:

Provider Business Practice Location Address
First Line	:	1220 N 10TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-4636
Country	:	US
Telephone Number	:	314-231-0143
Fax Number	:

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

Provider Enumeration Date	:	01/13/2020
Last Update Date	:	01/13/2020

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Directions to “ IAN FARMER MS CCC-SLP” Practice Location

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