Healthcare Provider Details

I. General information

NPI: 1073255659
Provider Name (Legal Business Name): JUST SPEECHIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 WEKIVA WAY
ST AUGUSTINE FL
32092-2453
US

IV. Provider business mailing address

1333 WEKIVA WAY
ST AUGUSTINE FL
32092-2453
US

V. Phone/Fax

Practice location:
  • Phone: 386-697-6174
  • Fax:
Mailing address:
  • Phone: 386-697-6174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: BRIANA GROEGER
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 386-697-6174