MEDICARE: ISLAND TELESPEECH, 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	261QH0700X	Hearing and Speech Clinic/Center

General Provider Information

NPI Number	:	1528756798
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ISLAND TELESPEECH, LLC

Provider Business Mailing Address
First Line	:	66 MARGARET RD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-3543
Country	:	US
Telephone Number	:	724-301-3310
Fax Number	:

Provider Business Practice Location Address
First Line	:	66 MARGARET RD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32176-3543
Country	:	US
Telephone Number	:	724-301-3310
Fax Number	:

Authorized Official
Title or Position	:	OWNER/SPEECH LANGUAGE PATHOLOGIST
Name	:	KRISTIN ROYLEEN BARTON
Credential	:	MA, CCC-SLP
Telephone Number	:	724-301-3310

Provider Enumeration Date	:	04/26/2023
Last Update Date	:	04/26/2023

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