Healthcare Provider Details

I. General information

NPI: 1730737834
Provider Name (Legal Business Name): MANDARIN READING CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2019
Last Update Date: 09/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13241 BARTRAM PARK BLVD UNIT 913
JACKSONVILLE FL
32258-5217
US

IV. Provider business mailing address

13241 BARTRAM PARK BLVD UNIT 913
JACKSONVILLE FL
32258-5217
US

V. Phone/Fax

Practice location:
  • Phone: 904-485-0590
  • Fax:
Mailing address:
  • Phone: 904-485-0590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: MARCY RUDOWITZ
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 904-485-0590