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General NPI Number Information
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NPI Number | 1962915025
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Entity Type | Organization
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Legal Business Name | PROGRESSION SPEECH THERAPY
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Dates
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Enumeration Date | 11/13/2017
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Last Update Date | 07/02/2020
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Provider Practice Location Address
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Address Line | 8010 BIRMAN ST
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City | MAITLAND
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State | FL
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Zip | 32751-8630
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Country | US
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Telephone | 315-729-9542
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Fax |
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Provider Business Mailing Address
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Address Line | 8010 BIRMAN ST
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City | MAITLAND
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State | FL
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Zip | 32751-8630
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Country | US
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Telephone | 315-729-9542
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | EVAN D SHERMAN
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Credential | MS CCC-SLP
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Telephone | 315-729-9542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SA12440
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License Number State | FL
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