Healthcare Provider Details

I. General information

NPI: 1467084921
Provider Name (Legal Business Name): JESSICA LORI WOYTANOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 04/23/2024
Certification Date: 04/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7410 BOYNTON BEACH BLVD STE B1
BOYNTON BEACH FL
33437-6157
US

IV. Provider business mailing address

7410 BOYNTON BEACH BLVD STE B1
BOYNTON BEACH FL
33437-6157
US

V. Phone/Fax

Practice location:
  • Phone: 561-223-1650
  • Fax:
Mailing address:
  • Phone: 561-223-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA18987
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: