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General NPI Number Information
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NPI Number | 1659703338
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Entity Type | Individual
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Provider Name | JADE CHAMPAGNE REYNOLDS
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Gender | Female
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Dates
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Enumeration Date | 08/05/2013
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Last Update Date | 08/05/2013
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Provider Practice Location Address
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Address Line | 12545 ORANGE DR SUITE 502
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City | DAVIE
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State | FL
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Zip | 33330-4306
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Country | US
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Telephone | 954-474-8048
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Fax | 954-474-8145
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Provider Business Mailing Address
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Address Line | 4501 NW 85TH AVE
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-1321
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Country | US
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Telephone | 954-298-1379
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SZ6305
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License Number State | FL
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