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General NPI Number Information
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NPI Number | 1982389367
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Entity Type | Individual
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Provider Name | MICAH ANDERSON
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Gender | Female
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Dates
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Enumeration Date | 06/21/2023
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Last Update Date | 06/21/2023
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Provider Practice Location Address
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Address Line | 803 N WILSON ST
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City | CRESTVIEW
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State | FL
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Zip | 32536-2639
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Country | US
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Telephone | 850-226-8279
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Fax | 850-226-8326
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Provider Business Mailing Address
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Address Line | 1200 CROSSWINDS LNDG
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City | FORT WALTON BEACH
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State | FL
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Zip | 32547-1174
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Country | US
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Telephone | 850-226-8279
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Fax | 850-226-8326
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | SZ11334
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License Number State | FL
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