Healthcare Provider Details

I. General information

NPI: 1538657937
Provider Name (Legal Business Name): ESCAROSA SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

10130 SUGAR CREEK CIR
PENSACOLA FL
32514-1688
US

IV. Provider business mailing address

10130 SUGAR CREEK CIR
PENSACOLA FL
32514-1688
US

V. Phone/Fax

Practice location:
  • Phone: 850-797-7106
  • Fax:
Mailing address:
  • Phone: 850-797-7106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA11900
License Number StateFL

VIII. Authorized Official

Name: AMANDA TECH
Title or Position: OWNER
Credential:
Phone: 850-712-0570