Healthcare Provider Details

I. General information

NPI: 1366097628
Provider Name (Legal Business Name): NEW DAY SPEECH THERAPY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 06/16/2022
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2180 A1A S STE 104 DEPREY CHIROPRACTIC BUILDING
ST AUGUSTINE FL
32080-6523
US

IV. Provider business mailing address

2180 A1A S STE 104 DEPREY CHIROPRACTIC BUILDING
ST AUGUSTINE FL
32080-6523
US

V. Phone/Fax

Practice location:
  • Phone: 904-377-7947
  • Fax: 904-471-6236
Mailing address:
  • Phone: 904-377-7947
  • Fax: 904-471-6236

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: MRS. CAROLYN SMALLWOOD
Title or Position: OWNER
Credential: SLP
Phone: 904-377-7947