MEDICARE: MRS. SARAH PLUMB WILSON 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 4686	FL

General Provider Information

NPI Number	:	1992841191
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH PLUMB WILSON CCC-SLP

Provider Business Mailing Address
First Line	:	12012 DEACONS CROFT LN
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33626-2561
Country	:	US
Telephone Number	:	813-818-0142
Fax Number	:

Provider Business Practice Location Address
First Line	:	3850 TAMPA RD
Second Line	:	BUILDING A, SUITE 200
City	:	PALM HARBOR
State	:	FL
Zip	:	34684-3670
Country	:	US
Telephone Number	:	727-786-5482
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	07/08/2007

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Directions to “ MRS. SARAH PLUMB WILSON CCC-SLP” Practice Location

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