Fame Speech and Myo

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

FAME SPEECH AND MYO

Practice address

13490 Gran Bay Pkwy Apt 732
Jacksonville, FL 32258-7439

Phone

(717) 875-0962

NPI assigned

Feb 16, 2022

Last updated

Nov 4, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Alexa Stubenrauch, MS CCC-SLPNPI 1154988467

Title

Speech Language Pathologist

Phone

(717) 875-0962

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Alexa Elyse Stubenrauch, M.S. CCC-SLP

  • Speech-Language Pathologist
  • Ponte Vedra Beach, FL
  • NPI 1154988467
  NPD Authorized official

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667520000000",
    "number": "1619622859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "178 VISTA GRANDE DR",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320821754",
            "telephone_number": "717-875-0962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13490 GRAN BAY PKWY APT 732",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322587439",
            "telephone_number": "717-875-0962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAME SPEECH AND MYO",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-16",
        "last_updated": "2022-11-04",
        "certification_date": "2022-09-26",
        "status": "A",
        "authorized_official_last_name": "STUBENRAUCH",
        "authorized_official_first_name": "ALEXA",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "717-875-0962",
        "authorized_official_credential": "MS CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Falls, MS, CCC-SLP
• Elise Michelle Fallucco, MD
• Michael A. Fallucco, M.D.
• Cindy Falor, LMHC,CAP
• Katherine D Falwell, PH.D., BCBA-D
• Famh Enterprise, LLC
• Familia Supporting Hand, LLC (Familia Supporting Hand)
• Families First Medical Group LLC
• Family Allergy & Asthma Consultants
• Family Behavioral Support

• 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 Nov 4, 2022; 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.