| NPI | 1376332585 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MALLORY PETERSON Speech Language Pathologist 321-615-4624 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2025-05-05 |
| Last Update Date | 2025-05-05 |