Khalilah Mignon Marques, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA11658 Issued in FL

Practice address

9957 Moorings Dr Ste 301
Jacksonville, FL 32257-2415

Phone

(904) 652-6165

Fax

(833) 241-4607

NPI assigned

Dec 16, 2011

Last updated

Jun 18, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in FL, GA2 enrollments

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Fresh Start Speech Therapy Services LLC.

  • Clinic/Center
  • Jacksonville, FL
  • NPI 1528591302

  GA

  Medicare reassignment Authorized official

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

{
    "created_epoch": "1323993600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655510400000",
    "number": "1932478153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9957 MOORINGS DR STE 301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322572415",
            "telephone_number": "904-652-6165",
            "fax_number": "833-241-4607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9957 MOORINGS DR STE 301",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322572415",
            "telephone_number": "904-652-6165",
            "fax_number": "833-241-4607"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1201 Fountain Park Cir",
            "address_purpose": "LOCATION",
            "city": "Brunswick",
            "state": "GA",
            "postal_code": "315204859",
            "country_code": "US",
            "telephone_number": "912-837-0008",
            "fax_number": "833-241-4607",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARQUES",
        "first_name": "KHALILAH",
        "middle_name": "MIGNON",
        "name_prefix": "Mrs.",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-12-16",
        "last_updated": "2022-06-18",
        "certification_date": "2022-06-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "CA",
            "license": "18647",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP011016",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA11658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Hope Marmo, PA-C
• Cecilia Marney, MSW
• Debra Breeanna Maron, PHARMD
• Kelli Maroney
• Kristen Marquardt, APRN
• Nathalia Silva Marques
• Evelyn Sofia Marquez Espina
• Alexei Marquez Fabre
• Christopher Phillip Marquez, M.D.
• Elizabeth J Marquez, M.D.

• Speech-Language Pathologist in Jacksonville, FL
• Providers in Jacksonville, 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 Jun 18, 2022; 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.