Foundations: Speech, Language and Learning Services

Primary specialty

Early Intervention Provider AgencyTaxonomy code 252Y00000X

License

SA5772 Issued in FL

Legal business name

FOUNDATIONS: SPEECH, LANGUAGE AND LEARNING SERVICES

Practice address

11787 Blueberry LN
Macclenny, FL 32063-4163

Phone

(904) 397-0004

NPI assigned

Dec 5, 2009

Last updated

Dec 5, 2009By 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

Angela C Clark, M.S., CCC-SLP

Title

Owner/ Speech Language Pathologist

Phone

(904) 397-0004

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1259971200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1259971200000",
    "number": "1841528619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11787 BLUEBERRY LN",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320634163",
            "telephone_number": "904-397-0004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11787 BLUEBERRY LN",
            "city": "MACCLENNY",
            "state": "FL",
            "postal_code": "320634163",
            "telephone_number": "904-397-0004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUNDATIONS: SPEECH, LANGUAGE AND LEARNING SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-12-05",
        "last_updated": "2009-12-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER/ SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "904-397-0004",
        "authorized_official_credential": "M.S., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": "FL",
            "license": "SA5772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INDIVIDUAL NPI NUMBER",
            "identifier": "1811123060",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001229700",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001229500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Danielle Grace Fender
• First Coast Imaging, LLC (Select Diagnostics)
• Florida Department of Children and Families (Northeast Florida State Hospital)
• Florida Department of Children and Families (NortheastFloridaStateHospitalCommunityBehavioralHealthcareServices)
• Florida Department of Health (Baker County Health Department)
• Traci Fuglestad
• Mary Martha Futch, O.D.
• George C. Weeks, DDS PA
• Natalie Gerido
• Kallie Rae Gibson, PT

• Early Intervention Provider Agency in Macclenny, FL
• Providers in Macclenny, FL by specialty
• Early Intervention Provider Agency in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 5, 2009; 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.