Healthcare Provider Details

I. General information

NPI: 1790907145
Provider Name (Legal Business Name): PROFESSIONAL SPEECH AND HEARING SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 09/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 SW 12TH ST STE 201C
OCALA FL
34471-6521
US

IV. Provider business mailing address

40 SW 12TH ST STE 201C
OCALA FL
34471-6521
US

V. Phone/Fax

Practice location:
  • Phone: 352-351-3977
  • Fax: 352-351-8642
Mailing address:
  • Phone: 352-351-3977
  • Fax: 352-351-8642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSA1494
License Number StateFL

VIII. Authorized Official

Name: MS. JAN S RIERSON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 352-351-3977