Healthcare Provider Details

I. General information

NPI: 1891631156
Provider Name (Legal Business Name): COASTAL SPEECH AND LANGUAGE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1439 N US HIGHWAY 1 STE A6
ORMOND BEACH FL
32174-0736
US

IV. Provider business mailing address

1439 N US HIGHWAY 1 STE A6
ORMOND BEACH FL
32174-0736
US

V. Phone/Fax

Practice location:
  • Phone: 386-450-8083
  • Fax: 386-777-3863
Mailing address:
  • Phone: 386-450-8083
  • Fax: 386-777-3863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER DUCKWORTH
Title or Position: OWNER, THERAPIST
Credential: MS, CCC-SLP
Phone: 386-346-0523