Basic Information
| Provider Information | |||||||||
| NPI: | 1205185246 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KRAMER | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | MICHAELA | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | M.A., R-SLP, CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 N RICHARD JACKSON BLVD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | PANAMA CITY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324072521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502356360 | ||||||||
| FaxNumber: | 8502358871 | ||||||||
| Practice Location | |||||||||
| Address1: | 120 N RICHARD JACKSON BLVD | ||||||||
| Address2: | SUITE 130 | ||||||||
| City: | PANAMA CITY BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 324072521 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8502356360 | ||||||||
| FaxNumber: | 8502358871 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2012 | ||||||||
| LastUpdateDate: | 09/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA11502 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.