MEDICARE: MERRITT SPEECH & LEARNING, INC.

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	225X00000X	Occupational Therapist	13759	FL
2	235Z00000X	Speech-Language Pathologist	SA 726	FL

General Provider Information

NPI Number	:	1548404312
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MERRITT SPEECH & LEARNING, INC.

Provider Business Mailing Address
First Line	:	1309 SAINT JOHNS BLUFF RD N STE 110
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-8396
Country	:	US
Telephone Number	:	904-721-4122
Fax Number	:	904-721-4112

Provider Business Practice Location Address
First Line	:	1309 SAINT JOHNS BLUFF RD N STE 110
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-8396
Country	:	US
Telephone Number	:	904-721-4122
Fax Number	:	904-721-4112

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MS. DANA MARIE MERRITT
Credential	:	MS CCC
Telephone Number	:	904-721-4122

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/08/2014

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