=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629359450
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | OF SPECIAL NOTE INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2011
-----------------------------------------------------
Last Update Date | 02/27/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12918 NIGHTSHADE PL
-----------------------------------------------------
City | LAKEWOOD RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34202-2818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-476-7464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8374 MARKET ST BOX 523
-----------------------------------------------------
City | LAKEWOOD RANCH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34202-5137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 847-476-7464
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, FL CTR FOR PROF. VOICE
-----------------------------------------------------
Name | DR. KAREN J. WICKLUND
-----------------------------------------------------
Credential | DM, MHS CCC-SLP
-----------------------------------------------------
Telephone | 847-476-7464
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 146009801
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------