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General NPI Number Information
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NPI Number | 1871644427
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Entity Type | Organization
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Legal Business Name | MARY WEST
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 1432 HEATHER COURT
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City | ST. AUGUSTINE
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State | FL
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Zip | 32092
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Country | US
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Telephone | 904-540-8408
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Fax | 904-797-1627
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Provider Business Mailing Address
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Address Line | 1432 HEATHER COURT
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City | ST. AUGUSTINE
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State | FL
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Zip | 32092
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Country | US
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Telephone | 904-540-8408
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Fax | 904-797-1627
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Authorized Official
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Title or Position | OWNER
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Name | MS. MARY B WEST
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Credential | MS , CCC-SLP
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Telephone | 904-540-8408
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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 | SA3573
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License Number State | FL
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