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General NPI Number Information
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NPI Number | 1194232561
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Entity Type | Organization
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Legal Business Name | MOSAIC THERAPY SERVICES LLC
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Dates
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Enumeration Date | 01/05/2018
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Last Update Date | 02/05/2022
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Provider Practice Location Address
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Address Line | 14700 TAMIAMI TRL N STE 1
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City | NAPLES
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State | FL
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Zip | 34110-6221
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Country | US
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Telephone | 239-249-5292
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Fax |
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Provider Business Mailing Address
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Address Line | 14700 TAMIAMI TRL N STE 1
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City | NAPLES
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State | FL
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Zip | 34110-6221
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Country | US
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Telephone | 239-249-5292
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | JESSICA ANN ROSEN
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Credential | MS CCC-SLP
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Telephone | 239-249-5292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA12231
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License Number State | FL
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