MEDICARE: PROCLAIM COMMUNICATION AND REHABILITATION SERVICES, LLC

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

General Provider Information

NPI Number	:	1952069882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROCLAIM COMMUNICATION AND REHABILITATION SERVICES, LLC

Provider Business Mailing Address
First Line	:	405 GUINEVERE DR
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32908-6431
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4680 LIPSCOMB ST NE STE 4
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32905-2984
Country	:	US
Telephone Number	:	321-209-0171
Fax Number	:

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	SHAVONNE MARISCAL
Credential	:	MS CCC-SLP
Telephone Number	:	321-209-0171

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	01/24/2024

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