| NPI | 1124486949 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JUSTINE THEISEN Owner 772-301-1207 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA10918) |
| Enumeration Date | 2016-02-08 |
| Last Update Date | 2018-07-12 |