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General NPI Number Information
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NPI Number | 1144896507
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Entity Type | Organization
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Legal Business Name | EAST PASCO SPEECH SERVICES
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Dates
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Enumeration Date | 05/27/2021
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Last Update Date | 05/27/2021
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Provider Practice Location Address
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Address Line | 12236 WOODLANDS CIR
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City | DADE CITY
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State | FL
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Zip | 33525-8287
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Country | US
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Telephone | 901-413-0495
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Fax |
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Provider Business Mailing Address
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Address Line | 12236 WOODLANDS CIR
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City | DADE CITY
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State | FL
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Zip | 33525-8287
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Country | US
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Telephone | 901-413-0495
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MS. JESSICA MABRY
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Credential | M.A.CCC-SLP CBIS
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Telephone | 901-413-0495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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