MEDICARE: BOUNCING BEANS PEDIATRIC THERAPY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist

General Provider Information

NPI Number	:	1306611512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOUNCING BEANS PEDIATRIC THERAPY, LLC

Provider Business Mailing Address
First Line	:	7867 LISA DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4171
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7867 LISA DR E
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4171
Country	:	US
Telephone Number	:	508-789-6457
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SPEECH LANGUAGE PATHOLOGIST
Name	:	HANNAH CAMERON
Credential	:	MS, CCC-SLP
Telephone Number	:	508-789-6457

Provider Enumeration Date	:	11/17/2023
Last Update Date	:	11/17/2023

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Directions to “BOUNCING BEANS PEDIATRIC THERAPY, LLC ” Practice Location

Language	Start Address	Practice Location

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