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General NPI Number Information
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NPI Number | 1992092837
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Entity Type | Individual
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Provider Name | JODI-ANN KONG M.A.
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Gender | Female
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 12702 SCIENCE DR
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City | ORLANDO
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State | FL
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Zip | 32826-3016
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Country | US
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Telephone | 407-281-0441
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Fax |
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Provider Business Mailing Address
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Address Line | 14326 SOUTHERN RED MAPLE DR
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City | ORLANDO
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State | FL
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Zip | 32828-6432
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Country | US
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Telephone | 954-663-9648
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Fax |
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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 | SZ5440
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License Number State | FL
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