Active NPI
Bettina Garcon
- Speech-Language Assistant
- Fort Pierce, FL
National Provider Identifier
1811323298
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Speech-Language Assistant
- License
- SI2176
- Practice address
- 4715 Kirby Loop Rd
Fort Pierce, FL 34981-5345 - Phone
- (772) 224-6749
- NPI assigned
- Sep 17, 2013
- Last updated
- Sep 17, 2013
- 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 Assistant | 2355S0801X | SI2176 | FL | Primary |
Addresses
Primary practice location
4715 Kirby Loop Rd
Fort Pierce, FL 34981-5345
Mailing address
3039 SE Wake Rd
Port St Lucie, FL 34984-6350
Phone (772) 224-6749
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 |
|---|---|---|---|
| SI2176 | FL | MD | Speech-Language Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Grace Therapies, LLC | Speech-Language Assistant | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1379376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1379376000000",
"number": "1811323298",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3039 SE WAKE RD",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349846350",
"telephone_number": "772-224-6749"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4715 KIRBY LOOP RD",
"city": "FORT PIERCE",
"state": "FL",
"postal_code": "349815345",
"telephone_number": "772-224-6749"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GARCON",
"first_name": "BETTINA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-09-17",
"last_updated": "2013-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "2355S0801X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Speech-Language Assistant",
"state": "FL",
"license": "SI2176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Pierce, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.