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General NPI Number Information
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NPI Number | 1932853595
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Entity Type | Organization
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Legal Business Name | DIVINE SPEECH AND SWALLOWING SOLUTIONS LLC
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Dates
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Enumeration Date | 02/11/2022
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 4631 NW 53RD AVE STE 102
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City | GAINESVILLE
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State | FL
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Zip | 32653-3402
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Country | US
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Telephone | 352-440-8147
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Fax |
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Provider Business Mailing Address
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Address Line | 4631 NW 53RD AVE STE 102
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City | GAINESVILLE
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State | FL
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Zip | 32653-3402
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. ERIC ZAMORA
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Credential |
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Telephone | 352-681-8679
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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 |
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License Number State |
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