Provider Demographics
NPI:1831840362
Name:GULFCOAST LEARNING LLC
Entity type:Organization
Organization Name:GULFCOAST LEARNING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:STOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:EDS CCC-SLP
Authorized Official - Phone:727-798-2742
Mailing Address - Street 1:9190 OAKHURST RD STE 3
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776-2137
Mailing Address - Country:US
Mailing Address - Phone:727-304-5590
Mailing Address - Fax:727-291-0043
Practice Address - Street 1:9190 OAKHURST RD STE 3
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776-2137
Practice Address - Country:US
Practice Address - Phone:727-304-5590
Practice Address - Fax:727-291-0043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-17
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15-08059619Medicaid
FL16-89974966Medicaid