Provider Demographics
NPI:1558061770
Name:FUNCTIONAL SPEECH SOLUTIONS, LLC
Entity Type:Organization
Organization Name:FUNCTIONAL SPEECH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:904-851-0428
Mailing Address - Street 1:108 ELMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3030
Mailing Address - Country:US
Mailing Address - Phone:904-851-0428
Mailing Address - Fax:
Practice Address - Street 1:108 ELMWOOD DR
Practice Address - Street 2:
Practice Address - City:SAINT JOHNS
Practice Address - State:FL
Practice Address - Zip Code:32259-3030
Practice Address - Country:US
Practice Address - Phone:904-851-0428
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-07
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
14062489OtherAMERICAN SPEECH LANGUAGE HEARING ASSOCIATION
FLSA14579OtherSTATE LICENSE