Provider Demographics
NPI:1649445131
Name:JCJ SPEECH PATHOLOGY, INC.
Entity type:Organization
Organization Name:JCJ SPEECH PATHOLOGY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS-CCC/SLP
Authorized Official - Phone:941-232-8929
Mailing Address - Street 1:7492 DEER CROSSING CT
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-7412
Mailing Address - Country:US
Mailing Address - Phone:941-232-8929
Mailing Address - Fax:
Practice Address - Street 1:7492 DEER CROSSING CT
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34240-7412
Practice Address - Country:US
Practice Address - Phone:941-232-8929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA3855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty