=====================================================
General NPI Number Information
=====================================================
NPI Number | 1578442091
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MIKALA AI MARKOWSKI BA, SLPA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/28/2025
-----------------------------------------------------
Last Update Date | 08/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 PLAZA DR # 6
-----------------------------------------------------
City | PALM COAST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32137-8550
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-346-0523
-----------------------------------------------------
Fax | 386-777-3863
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1265B COUNTY ROAD 204
-----------------------------------------------------
City | HASTINGS
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32145-6005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 386-225-7503
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2355S0801X
-----------------------------------------------------
Taxonomy Name | Speech-Language Assistant
-----------------------------------------------------
License Number | SI8166
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------