Provider Demographics
NPI:1710290309
Name:EMERALD COAST SPEECH SERVICES
Entity Type:Organization
Organization Name:EMERALD COAST SPEECH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:850-897-3013
Mailing Address - Street 1:1069 JOHN SIMS PKWY E
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2767
Mailing Address - Country:US
Mailing Address - Phone:850-897-3013
Mailing Address - Fax:850-897-0149
Practice Address - Street 1:1069 JOHN SIMS PKWY E
Practice Address - Street 2:SUITE # 4
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2767
Practice Address - Country:US
Practice Address - Phone:850-897-3013
Practice Address - Fax:850-897-0149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-23
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7885235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty