Provider Demographics
NPI:1841737772
Name:FIRST COAST SPEECH SERVICES, LLC
Entity Type:Organization
Organization Name:FIRST COAST SPEECH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAIN-MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:MCD, CCC-SLP
Authorized Official - Phone:904-755-1418
Mailing Address - Street 1:2662 MCCORMICK WOODS DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-5706
Mailing Address - Country:US
Mailing Address - Phone:904-755-1418
Mailing Address - Fax:
Practice Address - Street 1:2662 MCCORMICK WOODS DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-5706
Practice Address - Country:US
Practice Address - Phone:904-755-1418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-30
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty