Healthcare Provider Details

I. General information

NPI: 1770690125
Provider Name (Legal Business Name): ALANNA JOHNSON STEAPLE CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

278 LASALLE LEFALL DR
QUINCY FL
32351-5324
US

IV. Provider business mailing address

278 LASALLE LEFALL DR
QUINCY FL
32351-5324
US

V. Phone/Fax

Practice location:
  • Phone: 850-875-7200
  • Fax:
Mailing address:
  • Phone: 850-875-7200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3709
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number1119
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number9244800
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA3739
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: