MEDICARE: APEX SPEECH THERAPY, INC.

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	SA 4159	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	T0964	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730202615
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX SPEECH THERAPY, INC.

Provider Business Mailing Address
First Line	:	PO BOX 15745
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32406-5745
Country	:	US
Telephone Number	:	850-624-1721
Fax Number	:

Provider Business Practice Location Address
First Line	:	2685 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4351
Country	:	US
Telephone Number	:	850-624-1721
Fax Number	:

Authorized Official
Title or Position	:	SPEECH-LANGUAGE PATHOLOGIST
Name	:	NANCY KANSO
Credential	:
Telephone Number	:	850-624-1721

Provider Enumeration Date	:	04/07/2007
Last Update Date	:	08/22/2020

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Directions to “APEX SPEECH THERAPY, INC. ” Practice Location

Language	Start Address	Practice Location

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