Progressive Pediatric Therapy Services of Jacksonville

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

Legal business name

PROGRESSIVE PEDIATRIC THERAPY SERVICES OF JACKSONVILLE

Practice address

12350 Shore Acres Dr
Jacksonville, FL 32225-5670

Phone

(850) 325-6301

Fax

(850) 325-6302

NPI assigned

Jun 9, 2021

Organization subpart

No

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

Authorized official

Name

Kelly Quin Prejean, MA, CCC-SLPNPI 1477502011

Title

Clinic Director

Phone

(850) 325-6301

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.

• Kelly Quin Prejean, CCC-SLP

  • Speech-Language Pathologist
  • Tallahassee, FL
  • NPI 1477502011
  NPD Authorized official

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

{
    "created_epoch": "1623196800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1623196800000",
    "number": "1861069676",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 HERMITAGE BLVD",
            "city": "TALLAHASSEE",
            "state": "FL",
            "postal_code": "323087709",
            "telephone_number": "850-325-6301",
            "fax_number": "850-352-6302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12350 SHORE ACRES DR",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322255670",
            "telephone_number": "850-325-6301",
            "fax_number": "850-325-6302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROGRESSIVE PEDIATRIC THERAPY SERVICES OF JACKSONVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-06-09",
        "last_updated": "2021-06-09",
        "certification_date": "2021-06-09",
        "status": "A",
        "authorized_official_last_name": "PREJEAN",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "QUIN",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "850-325-6301",
        "authorized_official_credential": "MA, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Professional Dental Alliance of Jacksonville San Jose, PLLC
• Professional Diagnostic Reading MRI Inc.
• Professional Disability Provider Services, Inc.
• Professional Senior Advocates of Florida, Inc.
• Heather Diana Profetto, PTA
• Progressive Pediatrics,LLC
• Progressus Therapy, LLC
• Progressus Therapy, LLC
• Prohealth Dentist FL PLLC
• Lianelis Rafaela Prohenza Macias

• Behavior Analyst in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2021; 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.