Provider Demographics
NPI:1326055476
Name:DUFFEY, JAMES EDWARD (SLP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:EDWARD
Last Name:DUFFEY
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:MR
Other - First Name:JIM
Other - Middle Name:
Other - Last Name:DUFFEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SLP
Mailing Address - Street 1:1215 E.ORANGE ST.
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801
Mailing Address - Country:US
Mailing Address - Phone:863-802-3800
Mailing Address - Fax:863-802-0480
Practice Address - Street 1:1215 E.ORANGE ST.
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801
Practice Address - Country:US
Practice Address - Phone:863-802-3800
Practice Address - Fax:863-802-0480
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6759235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY905LOtherBCBS FL
FL890897400Medicaid
FLSA6759OtherFL LICENSE