| NPI | 1467234005 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRISTINE LEIGH TAVRISOV Owner, Speech Language Pathologist 904-910-1065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, |
| Enumeration Date | 2023-10-18 |
| Last Update Date | 2023-10-18 |