Provider Demographics
NPI:1477221414
Name:EMERALD COAST SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:EMERALD COAST SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SLP
Authorized Official - Prefix:
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC/SLP
Authorized Official - Phone:502-716-4007
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:SHALIMAR
Mailing Address - State:FL
Mailing Address - Zip Code:32579-0617
Mailing Address - Country:US
Mailing Address - Phone:502-716-4007
Mailing Address - Fax:
Practice Address - Street 1:308 MIRACLE STRIP PKWY SW UNIT 15C
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5214
Practice Address - Country:US
Practice Address - Phone:502-716-4007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-03
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech