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General NPI Number Information
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NPI Number | 1619521382
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Entity Type | Individual
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Provider Name | STEPHANIE SPEAGLE
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 01/22/2023
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Provider Practice Location Address
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Address Line | 358 STILES AVE # B
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City | ORANGE PARK
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State | FL
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Zip | 32073-4012
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Country | US
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Telephone | 904-264-8311
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Fax |
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Provider Business Mailing Address
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Address Line | 6205 LAKE TAHOE DR
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City | JACKSONVILLE
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State | FL
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Zip | 32256-5497
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Country | US
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Telephone | 904-635-7319
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH21414
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License Number State | FL
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