Provider Demographics
NPI:1285852384
Name:SIMMONS, JANE IVETTE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:IVETTE
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1283 MADELENA AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-4868
Mailing Address - Country:US
Mailing Address - Phone:407-404-0538
Mailing Address - Fax:
Practice Address - Street 1:8291 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-7890
Practice Address - Country:US
Practice Address - Phone:407-404-0538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 979235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL881447300Medicaid