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General NPI Number Information
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NPI Number | 1235941527
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Entity Type | Organization
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Legal Business Name | HAVEN SPEECH-LANGUAGE PATHOLOGY LLC
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Dates
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Enumeration Date | 01/23/2025
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Last Update Date | 01/23/2025
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Provider Practice Location Address
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Address Line | 568 W AMHERST CIR
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-4004
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Country | US
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Telephone | 321-795-1610
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Fax |
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Provider Business Mailing Address
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Address Line | 568 W AMHERST CIR
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City | SATELLITE BEACH
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State | FL
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Zip | 32937-4004
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOURDAN HAVEN
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Credential |
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Telephone | 321-795-1610
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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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