Atlantic Speech Therapy

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA5968 Issued in FL

Legal business name

ATLANTIC SPEECH THERAPY

Practice address

11512 Lake Mead Ave.
Suite 604
Jacksonville, FL 32256

Phone

(904) 652-5408

Fax

(877) 652-5052

NPI assigned

Oct 21, 2008

Organization subpart

No

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

Authorized official

Name

Jessica Otto

Title

Owner/Director

Phone

(904) 652-5408

Specialties & licenses 2

Addresses

Tax ID family

Atlantic Speech Therapy3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Atlantic Speech Therapy

  • Speech-Language Pathologist
  • Ponte Vedra, FL
  • NPI 1053855452
  NPD tax ID
• Atlantic Speech Therapy

  • Contractor
  • Jacksonville, FL
  • NPI 1881021749
  NPD tax ID

Locations

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

{
    "created_epoch": "1224547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427068800000",
    "number": "1568614642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE.",
            "address_2": "SUITE 604",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-652-5408",
            "fax_number": "877-652-5052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11512 LAKE MEAD AVE.",
            "address_2": "SUITE 604",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "32256",
            "telephone_number": "904-652-5408",
            "fax_number": "877-652-5052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ATLANTIC SPEECH THERAPY",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-21",
        "last_updated": "2015-03-23",
        "status": "A",
        "authorized_official_last_name": "OTTO",
        "authorized_official_first_name": "JESSICA",
        "authorized_official_title_or_position": "OWNER/DIRECTOR",
        "authorized_official_telephone_number": "904-652-5408"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA5968",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA9598",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Atlantic Family Medical Center of Jacksonville PL
• Atlantic Hearing Aid
• Atlantic Hearing Aid
• Atlantic Hearing Aid Solutions
• Atlantic Heart and Vascular Specialists, Inc
• Atlantic Speech Therapy
• Atlantic Spirit, LLC
• Atlantic Structural Energetic Therapy, Inc.
• Atlantic Surgery Center of Jacksonville Beach
• Atlantic Visiting Practice PA

• Speech-Language Pathologist in Jacksonville, FL
• Providers in Jacksonville, 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 Mar 23, 2015; 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.