Provider Demographics
NPI:1437323797
Name:LANGWORTHY, JACK ALLEN (AUD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:ALLEN
Last Name:LANGWORTHY
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13316 LAKE GEORGE PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618-3226
Mailing Address - Country:US
Mailing Address - Phone:813-961-8263
Mailing Address - Fax:
Practice Address - Street 1:1330 S FORT HARRISON AVE
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3313
Practice Address - Country:US
Practice Address - Phone:727-216-0700
Practice Address - Fax:727-216-0704
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY195231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS0597ZMedicare UPIN