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General NPI Number Information
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NPI Number | 1568970457
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Entity Type | Organization
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Legal Business Name | HEART SONG SPEECH AND LANGUAGE SERVICES LLC
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Dates
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Enumeration Date | 01/14/2018
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Last Update Date | 01/14/2018
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Provider Practice Location Address
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Address Line | 8402 LITTLE JOHN JCT
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City | NAVARRE
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State | FL
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Zip | 32566-1066
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Country | US
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Telephone | 678-621-9381
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Fax |
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Provider Business Mailing Address
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Address Line | 2746 CREEKS EDGE LN
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City | NAVARRE
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State | FL
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Zip | 32566-8665
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Country | US
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Telephone | 678-621-9381
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | LAURA WORTHINGTON ELLIS
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Credential | M.C.D., CCC-SLP
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Telephone | 678-621-9381
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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 | 12125
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License Number State | FL
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