Active NPI
Vanessa Harrison
- Speech-Language Pathologist
- Mount Dora, FL
National Provider Identifier
1134586035
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Pathologist
- License
- SA12061
- Practice address
- 255 Waterman Ave
Mount Dora, FL 32757-9530 - Phone
- (352) 383-0051
- NPI assigned
- Jan 22, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SA12061 | FL | Primary |
Addresses
Primary practice location
255 Waterman Ave
Mount Dora, FL 32757-9530
Mailing address
2957 W State Road 434 Ste 100
Longwood, FL 32779-4453
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SA12061 | FL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Florida Psychological Consultants Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Leesburg, FL
- NPI 1053339986
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1453420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637020800000",
"number": "1134586035",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2957 W STATE ROAD 434 STE 100",
"city": "LONGWOOD",
"state": "FL",
"postal_code": "327794453"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "255 WATERMAN AVE",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327579530",
"telephone_number": "352-383-0051"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRISON",
"first_name": "VANESSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-01-22",
"last_updated": "2021-11-16",
"certification_date": "2021-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "235Z00000X",
"taxonomy_group": "",
"desc": "Speech-Language Pathologist",
"state": "FL",
"license": "SA12061",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Dora, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.