Healthcare Provider Details

I. General information

NPI: 1982977229
Provider Name (Legal Business Name): JOY E. SHIPLEY M.A CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY E HAHN M.A CCC-SLP

II. Dates (important events)

Enumeration Date: 02/16/2012
Last Update Date: 03/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12901 BROLEMAN RD
ORLANDO FL
32832-6107
US

IV. Provider business mailing address

12901 BROLEMAN RD
ORLANDO FL
32832-6107
US

V. Phone/Fax

Practice location:
  • Phone: 407-641-0808
  • Fax: 407-812-4358
Mailing address:
  • Phone: 407-641-0808
  • Fax: 407-812-4358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberSA12226
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License NumberSZ5733
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ5733
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA12226
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: