MEDICARE: FIRST COAST SPEECH SERVICES, 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

General Provider Information

NPI Number	:	1841737772
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST COAST SPEECH SERVICES, LLC

Provider Business Mailing Address
First Line	:	2662 MCCORMICK WOODS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5706
Country	:	US
Telephone Number	:	904-755-1418
Fax Number	:

Provider Business Practice Location Address
First Line	:	2662 MCCORMICK WOODS DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32225-5706
Country	:	US
Telephone Number	:	904-755-1418
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOROTHY TRAIN-MARSH
Credential	:	MCD, CCC-SLP
Telephone Number	:	904-755-1418

Provider Enumeration Date	:	01/30/2017
Last Update Date	:	01/30/2017

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Directions to “FIRST COAST SPEECH SERVICES, LLC ” Practice Location

Language	Start Address	Practice Location

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