Healthcare Provider Details

I. General information

NPI: 1306228317
Provider Name (Legal Business Name): DEAF AND HARD OF HEARING SERVICES OF THE EMERALD COAST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2015
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 PLANTATION RD SUITE #11
PENSACOLA FL
32504-4206
US

IV. Provider business mailing address

7100 PLANTATION RD SUITE #11
PENSACOLA FL
32504-4206
US

V. Phone/Fax

Practice location:
  • Phone: 850-607-8453
  • Fax: 850-607-6935
Mailing address:
  • Phone: 850-607-8453
  • Fax: 850-607-6935

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW 10546
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA 10241
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: BONNIE C. BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential: LCSW
Phone: 850-607-8453