Healthcare Provider Details

I. General information

NPI: 1346351301
Provider Name (Legal Business Name): JACKSONVILLE SPEECH & HEARING CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 N DAVIS ST STE 101
JACKSONVILLE FL
32209-6808
US

IV. Provider business mailing address

1010 N. DAVIS STREET SUITE 101
JACKSONVILLE FL
32209-6808
US

V. Phone/Fax

Practice location:
  • Phone: 904-355-3403
  • Fax: 904-355-4149
Mailing address:
  • Phone: 904-355-3403
  • Fax: 904-355-4149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE NANGLE HOWLAND
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 904-355-3403