Healthcare Provider Details

I. General information

NPI: 1083377642
Provider Name (Legal Business Name): APRIL SIEGEL ASBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2021
Last Update Date: 10/20/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 26TH ST
LYNN HAVEN FL
32444-4713
US

IV. Provider business mailing address

180 BLUE STREAM WAY APT 13209
INLET BEACH FL
32461-8637
US

V. Phone/Fax

Practice location:
  • Phone: 850-769-5371
  • Fax: 850-872-9558
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ10461
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: