MEDICARE: FUNCTIONAL SPEECH SOLUTIONS, 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14062489	OTHER		AMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
2	SA14579	OTHER	FL	STATE LICENSE

General Provider Information

NPI Number	:	1558061770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FUNCTIONAL SPEECH SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	108 ELMWOOD DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3030
Country	:	US
Telephone Number	:	904-851-0428
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 ELMWOOD DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-3030
Country	:	US
Telephone Number	:	904-851-0428
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	KAYLA JONES
Credential	:	MS, CCC-SLP
Telephone Number	:	904-851-0428

Provider Enumeration Date	:	03/07/2023
Last Update Date	:	03/07/2023

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Directions to “FUNCTIONAL SPEECH SOLUTIONS, LLC ” Practice Location

Language	Start Address	Practice Location

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