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General NPI Number Information
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NPI Number | 1649445131
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Entity Type | Organization
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Legal Business Name | JCJ SPEECH PATHOLOGY, INC.
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Dates
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Enumeration Date | 04/25/2008
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Last Update Date | 04/25/2008
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Provider Practice Location Address
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Address Line | 7492 DEER CROSSING CT
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City | SARASOTA
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State | FL
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Zip | 34240-7412
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Country | US
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Telephone | 941-232-8929
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Fax |
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Provider Business Mailing Address
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Address Line | 7492 DEER CROSSING CT
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City | SARASOTA
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State | FL
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Zip | 34240-7412
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Country | US
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Telephone | 941-232-8929
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. JILL C JOHNSON
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Credential | M.S.-CCC/SLP
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Telephone | 941-232-8929
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA3855
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License Number State | FL
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