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General NPI Number Information
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NPI Number | 1295776763
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Entity Type | Organization
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Legal Business Name | SPEECH PATHOLOGY ASSOCIATES, P.A.
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1463 NECTARINE ST
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-3027
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Country | US
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Telephone | 904-635-3179
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Fax | 904-246-7259
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Provider Business Mailing Address
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Address Line | 1595 LINKSIDE DR
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-7308
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Country | US
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Telephone | 904-635-3179
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Fax | 904-246-7259
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Authorized Official
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Title or Position | PRESIDENT/SPEECH PATHOLOGIST
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Name | DEBORAH ROBERTS
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Credential | CCC-SLP
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Telephone | 904-635-3179
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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 | SA3317
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License Number State | FL
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