MEDICARE: GRACE MARCELLE POPE CCC-SLP

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	SA24330	FL

General Provider Information

NPI Number	:	1346098738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRACE MARCELLE POPE CCC-SLP

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	653 W 8TH ST
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32209-6511
Country	:	US
Telephone Number	:	904-383-1017
Fax Number	:	904-244-6864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	02/12/2026

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Directions to “ GRACE MARCELLE POPE CCC-SLP” Practice Location

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