Healthcare Provider Details

I. General information

NPI: 1164688628
Provider Name (Legal Business Name): ALISON E CORNELIUS SLP-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2008
Last Update Date: 10/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9471 BAYMEADOWS RD SUITE 304
JACKSONVILLE FL
32256-7932
US

IV. Provider business mailing address

9471 BAYMEADOWS RD SUITE 304
JACKSONVILLE FL
32256-7932
US

V. Phone/Fax

Practice location:
  • Phone: 904-733-5034
  • Fax:
Mailing address:
  • Phone: 904-733-5034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI1552
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: