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General NPI Number Information
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NPI Number | 1770718462
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Entity Type | Organization
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Legal Business Name | JESSICA M. BOOTH M.S.CCC-SLP & ASSOC. ,P.A.
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Dates
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Enumeration Date | 05/25/2009
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Last Update Date | 07/14/2009
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Provider Practice Location Address
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Address Line | 7782 N SOUTHWOOD CIR
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City | DAVIE
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State | FL
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Zip | 33328-3810
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Country | US
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Telephone | 954-319-7609
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Fax | 440-965-4303
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Provider Business Mailing Address
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Address Line | 7782 N SOUTHWOOD CIR
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City | DAVIE
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State | FL
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Zip | 33328-3810
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Country | US
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Telephone | 954-319-7609
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Fax | 440-965-4303
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Authorized Official
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Title or Position | SPEECH-LANGUAGE PATHOLOGIST/OWNER
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Name | MS. JESSICA MARIE BOOTH
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Credential | M. S. CCC-SLP
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Telephone | 954-319-7609
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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 | SA 8417
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License Number State | FL
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