MEDICARE: SIMPLYSPEECH, 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	:	1538778790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMPLYSPEECH, LLC

Provider Business Mailing Address
First Line	:	8066 WHITE CRANE CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34747-2217
Country	:	US
Telephone Number	:	717-580-9205
Fax Number	:

Provider Business Practice Location Address
First Line	:	8066 WHITE CRANE CT
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34747-2217
Country	:	US
Telephone Number	:	717-580-9205
Fax Number	:

Authorized Official
Title or Position	:	SLP/OWNER
Name	:	MRS. JILL M BURNSIDE
Credential	:	M.A., CCC-SLP
Telephone Number	:	717-580-9205

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/23/2020

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Directions to “SIMPLYSPEECH, LLC ” Practice Location

Language	Start Address	Practice Location

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