Provider Demographics
NPI:1518246909
Name:FOUNTAIN, TREEVA
Entity Type:Individual
Prefix:
First Name:TREEVA
Middle Name:
Last Name:FOUNTAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 HONORS WAY THE FLORIDA STATE UNIVERSITY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-1200
Mailing Address - Country:US
Mailing Address - Phone:850-644-2238
Mailing Address - Fax:
Practice Address - Street 1:127 HONORS WAY THE FLORIDA STATE UNIVERSITY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-1200
Practice Address - Country:US
Practice Address - Phone:850-644-2238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-16
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3695082235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist