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General NPI Number Information
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NPI Number | 1225164106
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Entity Type | Individual
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Provider Name | KOREN LYNN TOLENTINO CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14444 BEACH BLVD SUITE 500
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City | JACKSONVILLE
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State | FL
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Zip | 32250-2079
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Country | US
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Telephone | 904-858-7510
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Fax | 904-858-7540
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Provider Business Mailing Address
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Address Line | 13364 BEACH BLVD UNIT 204
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City | JACKSONVILLE
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State | FL
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Zip | 32224-0265
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Country | US
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Telephone | 904-223-1075
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | SA8896
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License Number State | FL
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