Healthcare Provider Details

I. General information

NPI: 1639052889
Provider Name (Legal Business Name): JANELLE NICOLE MCKIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8177 GLADES RD STE 202
BOCA RATON FL
33434-4022
US

IV. Provider business mailing address

10165 NW 69TH MNR
PARKLAND FL
33076-2904
US

V. Phone/Fax

Practice location:
  • Phone: 561-270-4433
  • Fax: 561-931-4242
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number8029
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: