Provider Demographics
NPI:1457997769
Name:DEVLIN, JOSEPH JOHN III (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JOHN
Last Name:DEVLIN
Suffix:III
Gender:M
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6278 N FEDERAL HWY # 432
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1916
Mailing Address - Country:US
Mailing Address - Phone:954-440-8978
Mailing Address - Fax:
Practice Address - Street 1:5975 N FEDERAL HWY STE 244
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-2652
Practice Address - Country:US
Practice Address - Phone:954-440-8978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA5318OtherFLORIDA LICENSE SPEECH LANGUAGE PATHOLOGIST