Marilyn Bosworth, SLP

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

SA6123 Issued in FL

Legal business name

MARILYN BOSWORTH, SLP

Practice address

105 Alsace CT
Ponte Vedra Beach, FL 32082-2950

Phone

(904) 343-4727

NPI assigned

Aug 21, 2015

Last updated

Aug 21, 2015By 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

Mr. Jonathan Walton Bosworth, HUSBAND

Title

President

Phone

(904) 273-8266

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1440115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440115200000",
    "number": "1649647900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 ALSACE CT",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822950",
            "telephone_number": "904-343-4727"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 ALSACE CT",
            "city": "PONTE VEDRA BEACH",
            "state": "FL",
            "postal_code": "320822950",
            "telephone_number": "904-343-4727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARILYN BOSWORTH, SLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-08-21",
        "last_updated": "2015-08-21",
        "status": "A",
        "authorized_official_last_name": "BOSWORTH",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_middle_name": "WALTON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-273-8266",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "HUSBAND"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "FL",
            "license": "SA6123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 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.