MEDICARE: MRS. ELOISE PEGGY DORSEY MS-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

General Provider Information

NPI Number	:	1609482959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELOISE PEGGY DORSEY MS-CCC-SLP

Provider Business Mailing Address
First Line	:	2899 COUNTRY CLUB BLVD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5733
Country	:	US
Telephone Number	:	757-287-0993
Fax Number	:

Provider Business Practice Location Address
First Line	:	2899 COUNTRY CLUB BLVD
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32073-5733
Country	:	US
Telephone Number	:	757-287-0993
Fax Number	:

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

Provider Enumeration Date	:	09/22/2020
Last Update Date	:	02/24/2022

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