MEDICARE: COASTAL COMMUNICATION CLINIC, 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	:	1790583888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COASTAL COMMUNICATION CLINIC, LLC

Provider Business Mailing Address
First Line	:	2922 YELLOWHAMMER WAY
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-0107
Country	:	US
Telephone Number	:	318-505-2035
Fax Number	:

Provider Business Practice Location Address
First Line	:	2922 YELLOWHAMMER WAY
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34655-0107
Country	:	US
Telephone Number	:	318-505-2035
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KATELIN JOHNSON
Credential	:	M.S., CCC-SLP
Telephone Number	:	318-505-2035

Provider Enumeration Date	:	03/04/2025
Last Update Date	:	03/04/2025

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Directions to “COASTAL COMMUNICATION CLINIC, LLC ” Practice Location

Language	Start Address	Practice Location

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