Healthcare Provider Details

I. General information

NPI: 1285637892
Provider Name (Legal Business Name): AUDIOLOGY AND SPEECH PATHOLOGY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 04/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3540 FOREST HILL BLVD STE 205
WEST PALM BEACH FL
33406-5878
US

IV. Provider business mailing address

3540 FOREST HILL BLVD STE 205
WEST PALM BEACH FL
33406-5878
US

V. Phone/Fax

Practice location:
  • Phone: 561-649-4006
  • Fax: 561-969-6621
Mailing address:
  • Phone: 561-649-4006
  • Fax: 561-969-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number StateFL

VIII. Authorized Official

Name: MEL GRANT
Title or Position: PRESIDENT
Credential: AU.D.
Phone: 561-649-4006