Provider Demographics
NPI:1457387961
Name:SURVANT, MAUREEN C (SLP/CCC EDD)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:C
Last Name:SURVANT
Suffix:
Gender:F
Credentials:SLP/CCC EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8317 FRONT BEACH RD
Mailing Address - Street 2:SUITE 34 C
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32407-4885
Mailing Address - Country:US
Mailing Address - Phone:850-233-3984
Mailing Address - Fax:850-233-3954
Practice Address - Street 1:8317 FRONT BEACH RD
Practice Address - Street 2:SUITE 34 C
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-4885
Practice Address - Country:US
Practice Address - Phone:850-233-3984
Practice Address - Fax:850-233-3954
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 3760235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist