Healthcare Provider Details

I. General information

NPI: 1255117156
Provider Name (Legal Business Name): ANTONICE LEA MORIN M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2023
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 OFFICE PARK DR STE 4
PALM COAST FL
32137-3831
US

IV. Provider business mailing address

34 RUSSELL DR
PALM COAST FL
32164-6909
US

V. Phone/Fax

Practice location:
  • Phone: 386-446-9935
  • Fax:
Mailing address:
  • Phone: 732-616-6038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA24808
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: