Provider Demographics
NPI:1659905412
Name:SOUTHERN SPEECH PRACTITIONERS LLC
Entity Type:Organization
Organization Name:SOUTHERN SPEECH PRACTITIONERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCARLET
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:850-748-2819
Mailing Address - Street 1:116 FAIRPOINT DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32561-4306
Mailing Address - Country:US
Mailing Address - Phone:850-748-2819
Mailing Address - Fax:850-733-9419
Practice Address - Street 1:116 FAIRPOINT DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32561-4306
Practice Address - Country:US
Practice Address - Phone:850-748-2819
Practice Address - Fax:850-733-9419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-02
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty