Provider Demographics
NPI:1417335324
Name:TALBOT, CHARLENE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:TALBOT
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:TALBOT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CCC-SLP
Mailing Address - Street 1:PO BOX 620157
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32762-0157
Mailing Address - Country:US
Mailing Address - Phone:407-710-5670
Mailing Address - Fax:
Practice Address - Street 1:950 3RD ST N STE D
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-1714
Practice Address - Country:US
Practice Address - Phone:407-710-5670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6608235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist