Facts
- Status
- A
- Credential
- MS CCC SLP
- Type
- Individual
- Enumeration date
- 2018-01-30
- Last updated
- 2026-09-07
Specialties
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
- 235Z00000XSpeech-Language Pathologist,
Licenses
- License VA
- 2203001055
- License CO
- SLP.0006050
- License NH
- 3586
- License TX
- 122923
- License FL
- SA21631
- License CA
- 37750
- License PA
- SL018888
- License NM
- SAH-2025-0405
- License WA
- SLP.LL.70150437
- License AZ
- 10280774
Location
- Practice location
- 7615 DEVONBRIDGE GARDEN WAY
- City
- APOLLO BEACH FL
- Postal code
- 335721516
- Phone
- 813-928-5113
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.