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General NPI Number Information
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NPI Number | 1710290309
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Entity Type | Organization
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Legal Business Name | EMERALD COAST SPEECH SERVICES LLC
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Dates
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Enumeration Date | 07/23/2010
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 1069 JOHN SIMS PKWY E STE 4
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City | NICEVILLE
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State | FL
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Zip | 32578-2768
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Country | US
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Telephone | 850-897-3013
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Fax | 850-897-0149
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Provider Business Mailing Address
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Address Line | 1069 JOHN SIMS PKWY E STE 4
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City | NICEVILLE
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State | FL
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Zip | 32578-2768
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Country | US
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Telephone | 850-897-3013
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Fax | 850-897-0149
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Authorized Official
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Title or Position | OWNER/SPEECH PATHOLOGIST
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Name | MRS. KRISTEN MARIE BOWERS
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Credential | M.S. CCC-SLP
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Telephone | 850-897-3013
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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 | SA7885
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License Number State | FL
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