Provider Demographics
NPI:1790583888
Name:COASTAL COMMUNICATION CLINIC, LLC
Entity type:Organization
Organization Name:COASTAL COMMUNICATION CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:318-505-2035
Mailing Address - Street 1:2922 YELLOWHAMMER WAY
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-0107
Mailing Address - Country:US
Mailing Address - Phone:318-505-2035
Mailing Address - Fax:
Practice Address - Street 1:2922 YELLOWHAMMER WAY
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-0107
Practice Address - Country:US
Practice Address - Phone:318-505-2035
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty