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General NPI Number Information
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NPI Number | 1366140568
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Entity Type | Organization
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Legal Business Name | LOGOS COMMUNICATION THERAPY SERVICES, LLC
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Dates
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Enumeration Date | 02/17/2023
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Last Update Date | 11/06/2024
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Provider Practice Location Address
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Address Line | 106 BLACK BEAR CIRCLE
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City | NICEVILLE
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State | FL
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Zip | 32578
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Country | US
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Telephone | 850-830-3314
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Fax | 850-904-0355
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Provider Business Mailing Address
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Address Line | 106 BLACK BEAR CIR
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City | NICEVILLE
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State | FL
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Zip | 32578-1202
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Country | US
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Telephone | 850-830-3314
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Fax | 850-904-0355
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | ENRI Y FORT
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Credential | MS,CCC-SLP
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Telephone | 850-830-3314
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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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