=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619062031
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SPEECH AND LANGUAGE SERVICES OF THE TREASURE COAST, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 07/28/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1607 NW FEDERAL HWY
-----------------------------------------------------
City | STUART
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34994-9600
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-291-1614
-----------------------------------------------------
Fax | 866-284-6714
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2120 SE HERRON AVENUE
-----------------------------------------------------
City | PORT ST. LUCIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34952-5853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 772-489-1714
-----------------------------------------------------
Fax | 866-284-6714
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SPEECH LANG PATHOLOGIST
-----------------------------------------------------
Name | MRS. JOANNE MARIE MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 772-489-1714
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------