Provider Demographics
NPI:1497726640
Name:AUSTIN, GENEVA E (SLP, MS, CCC)
Entity Type:Individual
Prefix:MS
First Name:GENEVA
Middle Name:E
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:SLP, MS, CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13205 PARKHURST CT
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-5756
Mailing Address - Country:US
Mailing Address - Phone:813-263-9554
Mailing Address - Fax:813-263-9554
Practice Address - Street 1:13205 PARKHURST CT
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33569-5756
Practice Address - Country:US
Practice Address - Phone:813-263-9554
Practice Address - Fax:813-263-9554
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7832235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY902FOtherBCBS