Provider Demographics
NPI:1396932786
Name:THE SPEECH THERAPY CLOSET
Entity type:Organization
Organization Name:THE SPEECH THERAPY CLOSET
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAISLIP
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:904-233-4552
Mailing Address - Street 1:450 STATE ROAD 13
Mailing Address - Street 2:SUITE 106 - 235
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3860
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:904-677-7800
Practice Address - Street 1:5213 BASCO CT
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:FL
Practice Address - Zip Code:32033-4028
Practice Address - Country:US
Practice Address - Phone:904-233-4552
Practice Address - Fax:904-677-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty