Provider Demographics
NPI:1437347010
Name:ECKHARDT, REMAI JACQUELINE (MS CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:REMAI
Middle Name:JACQUELINE
Last Name:ECKHARDT
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8825 SE LONGVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HOBE SOUND
Mailing Address - State:FL
Mailing Address - Zip Code:33455-7420
Mailing Address - Country:US
Mailing Address - Phone:772-781-1490
Mailing Address - Fax:561-747-8388
Practice Address - Street 1:169 TEQUESTA DR
Practice Address - Street 2:SUITE 24E
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2768
Practice Address - Country:US
Practice Address - Phone:561-747-8188
Practice Address - Fax:561-747-8388
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2012-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7527235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12009739OtherASHA
FL892241100Medicaid
FLSA7527OtherSTATE LISENCE