Healthcare Provider Details

I. General information

NPI: 1881171908
Provider Name (Legal Business Name): JONATHAN RAY DUBOIS M.A., CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2018
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 SHERBURN CT
ORLANDO FL
32828-9017
US

IV. Provider business mailing address

5224 DRISCOLL CT
BELLE ISLE FL
32812-1002
US

V. Phone/Fax

Practice location:
  • Phone: 407-810-2773
  • Fax: 407-867-6203
Mailing address:
  • Phone: 321-330-5486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: