| NPI | 1528367380 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JERILYN E AGNESS Owner 239-225-3682 |
| Organization Subpart ? | No |
| Primary Taxonomy | 235Z00000X Speech-Language Pathologist, (Licence: FL SA9847) |
| Enumeration Date | 2011-03-19 |
| Last Update Date | 2011-03-19 |