Facts
- Status
- A
- Credential
- M.S. CCC
- Type
- Individual
- Enumeration date
- 2007-01-29
- Last updated
- 2017-03-08
Specialties
Licenses
- License FL
- SA 7860
Location
- Practice location
- 2235 LAKEWOOD TER
- City
- NOKOMIS FL
- Postal code
- 342753528
- Phone
- 941-400-7106
Medicare
- PECOS
- No PECOS enrollment row matched this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.