Provider Demographics
NPI:1417180761
Name:JACKSONVILLE'S CHILDREN'S SPEECH CENTER, INC.
Entity Type:Organization
Organization Name:JACKSONVILLE'S CHILDREN'S SPEECH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:K
Authorized Official - Last Name:DROOGSMA
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:904-235-3444
Mailing Address - Street 1:1415 ATLANTIC BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NEPTUNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32266-1715
Mailing Address - Country:US
Mailing Address - Phone:904-235-3444
Mailing Address - Fax:904-396-7403
Practice Address - Street 1:1415 ATLANTIC BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:NEPTUNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32266-1715
Practice Address - Country:US
Practice Address - Phone:904-235-3444
Practice Address - Fax:904-396-7403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-02
Last Update Date:2009-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9206235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8913340Medicaid