Provider Demographics
NPI:1912109612
Name:PHILLIPS, JANICE LYNN (MS, CCCSLP)
Entity Type:Individual
Prefix:MS
First Name:JANICE
Middle Name:LYNN
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 OAK RIDGE PL
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32408-5200
Mailing Address - Country:US
Mailing Address - Phone:850-233-8371
Mailing Address - Fax:
Practice Address - Street 1:110 OAK RIDGE PL
Practice Address - Street 2:
Practice Address - City:PANAMA CITY BEACH
Practice Address - State:FL
Practice Address - Zip Code:32408-5200
Practice Address - Country:US
Practice Address - Phone:850-233-8371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist