Mica Collins Booth

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA10301 Issued in FL

Practice address

630 Griffin Ave
Lady Lake, FL 32159-8101

Phone

(352) 750-6619

NPI assigned

Feb 23, 2010

Last updated

Apr 24, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1266883200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745452800000",
    "number": "1073835666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "630 GRIFFIN AVE",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321598101",
            "telephone_number": "352-750-6619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "630 GRIFFIN AVE",
            "city": "LADY LAKE",
            "state": "FL",
            "postal_code": "321598101",
            "telephone_number": "352-750-6619"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9377 SE 164th Pl",
            "address_purpose": "LOCATION",
            "city": "Summerfield",
            "state": "FL",
            "postal_code": "344915898",
            "country_code": "US",
            "telephone_number": "229-269-7251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BOOTH",
        "first_name": "MICA",
        "middle_name": "COLLINS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-02-23",
        "last_updated": "2025-04-24",
        "certification_date": "2025-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA10301",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Lady Lake, FL
• Providers in Lady Lake, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.