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General NPI Number Information
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NPI Number | 1578954962
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Entity Type | Organization
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Legal Business Name | BAYSIDE SPEECH THERAPY, INC.
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Dates
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Enumeration Date | 02/07/2015
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Last Update Date | 08/02/2024
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Provider Practice Location Address
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Address Line | 5647 GULF DR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4019
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Country | US
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Telephone | 813-435-3355
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Fax |
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Provider Business Mailing Address
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Address Line | 5647 GULF DR
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4019
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Country | US
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Telephone | 813-435-3355
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Fax |
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST
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Name | MRS. NICOLE M YATES
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Credential | MS CCC-SLP
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Telephone | 813-944-9594
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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License Number |
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License Number State |
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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 |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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