NPIMap

Organization Active NPI

Lively Speech and Language Therapy, LLC

Doing business as Lively Speech and Language Therapy

  • Speech-Language Pathologist
  • St Augustine, FL
National Provider Identifier
1912614488
Registry record updated Jan 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
Legal business name
LIVELY SPEECH AND LANGUAGE THERAPY, LLC
Doing business as
Lively Speech and Language Therapy
Practice address
111 Nature Walk Pkwy Unit 108
St Augustine, FL 32092-3065
Phone
(904) 729-6759
Fax
(904) 490-8549
NPI assigned
Nov 3, 2022
Last updated
Jan 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2024

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

Authorized official

Name
Ms. Sarah Lively, CCC-SLPNPI 1740721885
Title
Ceo & Founder
Phone
(904) 729-6759

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Occupational Therapist 225XP0200X NU
Speech-Language Pathologist 235Z00000X NU Primary

Addresses

Primary practice location

111 Nature Walk Pkwy Unit 108
St Augustine, FL 32092-3065

Mailing address

111 Nature Walk Pkwy Unit 108
St Augustine, FL 32092-3065
Phone (904) 729-6759

Other identifiers 7

IdentifierTypeStateIssuer
SA12730OtherFLFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY KIMBERLY KENNELL
SA19092OtherFLFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SONYA OLSEN
SA19465OtherFLFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY JULIANNE TRAUNER
SA16825OtherFLFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SAMANTHA REPALONE
SA15493OtherFLFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY AJA WALKER
SA14057OtherFLFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SARAH LIVELY
SA20932OtherFLFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY MALLORY ABERCROMBIE

Other names 1

  • Lively Speech and Language Therapy Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address Sarah@livelyslp.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230726002771 FL Part B Supplier - Clinic/Group Practice 6406217223 Receives reassigned benefits from 1 practitioner
Practice locations: St Augustine, FL

National Provider Directory

National Provider Directory

Interoperability endpoints

  • Direct secure messaging: sarah@livelyslp.com

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1667433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1705017600000",
    "number": "1912614488",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NATURE WALK PKWY UNIT 108",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923065",
            "telephone_number": "904-729-6759",
            "fax_number": "904-490-8549"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NATURE WALK PKWY UNIT 108",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320923065",
            "telephone_number": "904-729-6759",
            "fax_number": "904-490-8549"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIVELY SPEECH AND LANGUAGE THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-03",
        "last_updated": "2024-01-12",
        "certification_date": "2024-01-12",
        "status": "A",
        "authorized_official_last_name": "LIVELY",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "CEO & FOUNDER",
        "authorized_official_telephone_number": "904-729-6759",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "225XP0200X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist, Pediatrics",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY KIMBERLY KENNELL",
            "identifier": "SA12730",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SONYA OLSEN",
            "identifier": "SA19092",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY JULIANNE TRAUNER",
            "identifier": "SA19465",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SAMANTHA REPALONE",
            "identifier": "SA16825",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY AJA WALKER",
            "identifier": "SA15493",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SARAH LIVELY",
            "identifier": "SA14057",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY MALLORY ABERCROMBIE",
            "identifier": "SA20932",
            "state": "FL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "Sarah@livelyslp.com",
            "affiliation": "N",
            "endpointDescription": "Sarah@livelyslp.com",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "cloud",
            "address_1": "95 Tavernier Dr",
            "city": "Ponte Vedra",
            "state": "FL",
            "country_code": "US",
            "postal_code": "320810676",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Lively Speech and Language Therapy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lively Speech and Language Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Augustine, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.