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General NPI Number Information
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NPI Number | 1477221414
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Entity Type | Organization
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Legal Business Name | EMERALD COAST SPEECH THERAPY LLC
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Dates
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Enumeration Date | 09/03/2021
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 308 MIRACLE STRIP PKWY SW UNIT 15C
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5214
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Country | US
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Telephone | 502-716-4007
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 617
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City | SHALIMAR
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State | FL
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Zip | 32579-0617
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Country | US
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Telephone | 502-716-4007
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Fax |
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Authorized Official
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Title or Position | OWNER SLP
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Name | RHONDA L LEAKE
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Credential | MS CCC/SLP
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Telephone | 502-716-4007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number |
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License Number State |
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