Provider Demographics
NPI:1477891307
Name:TRAIN, DOROTHY IJEANETTE (MCD, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:IJEANETTE
Last Name:TRAIN
Suffix:
Gender:F
Credentials:MCD, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12877 DAYBREAK CT E
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7095
Mailing Address - Country:US
Mailing Address - Phone:904-755-1418
Mailing Address - Fax:
Practice Address - Street 1:12877 DAYBREAK CT E
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7095
Practice Address - Country:US
Practice Address - Phone:904-755-1418
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-28
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA12892235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0088776600Medicaid