Ponte Vedra Speech Therapy LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

Legal business name

PONTE VEDRA SPEECH THERAPY LLC

Practice address

30 Tavernier Dr Unit B
Ponte Vedra, FL 32081-0677

Phone

(904) 844-3136

Fax

(904) 789-6295

NPI assigned

Nov 4, 2024

Organization subpart

Yes

Parent organization

PONTE VEDRA SPEECH LANGUAGE AND LEARNING LLCAs reported in NPPES

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

Authorized official

Name

Sonya Marie Olsen, MS, CCC-SLPNPI 1295291177

Title

Ceo

Phone

(904) 844-3136

Specialties & licenses 1

Addresses

Part of

Ponte Vedra Speech Language

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Sonya Marie Olsen, M.S., CCC-SLP

  • Speech-Language Pathologist
  • Ponte Vedra, FL
  • NPI 1295291177
  NPD Authorized official

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

{
    "created_epoch": "1730678400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1902629587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 TAVERNIER DR UNIT B",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320810677",
            "telephone_number": "904-844-3136",
            "fax_number": "904-789-6295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 TAVERNIER DR UNIT B",
            "city": "PONTE VEDRA",
            "state": "FL",
            "postal_code": "320810677",
            "telephone_number": "904-844-3136",
            "fax_number": "904-789-6295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PONTE VEDRA SPEECH THERAPY LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PONTE VEDRA SPEECH LANGUAGE AND LEARNING LLC",
        "enumeration_date": "2024-11-04",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "OLSEN",
        "authorized_official_first_name": "SONYA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "904-844-3136",
        "authorized_official_credential": "MS, CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Ponte Vedra, FL
• Providers in Ponte Vedra, 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, 2024; 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.