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General NPI Number Information
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NPI Number | 1386354496
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Entity Type | Individual
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Provider Name | TEAGAN KYLIE MARQUARDT CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 08/27/2024
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Provider Practice Location Address
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Address Line | 2301 LUCIEN WAY STE 325
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City | MAITLAND
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State | FL
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Zip | 32751-7020
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Country | US
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Telephone | 800-774-7785
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Fax |
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Provider Business Mailing Address
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Address Line | 1255 N 140 W
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City | ANGOLA
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State | IN
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Zip | 46703-9406
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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 |
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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 | SA22877
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 22008846A
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License Number State | IN
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