Micah Anderson
Individual provider Active NPI Speech-Language Pathologist · Crestview, FL
NPI 1982389367 · NPPES record last updated Jun 21, 2023
Key facts
- NPI
- 1982389367
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Speech-Language Pathologist 235Z00000X
- License
- SZ11334 (FL)
- Practice address
- 803 N Wilson St
Crestview, FL 32536-2639 - Phone
- (850) 226-8279
- Fax
- (850) 226-8326
- NPI assigned
- Jun 21, 2023
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SZ11334 | FL | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Magnolia Rehab Services | Speech-Language Pathologist | Past |
Accepting new patients |
| Magnolia Rehab Services | Speech-Language Pathologist | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Speech-Language Pathologist | 235Z00000X | SZ11334 | FL | Yes |
Addresses
Primary practice location
803 N Wilson St
Crestview, FL 32536-2639
Mailing address
1200 Crosswinds LNDG
Fort Walton Beach, FL 32547-1174
Phone (850) 226-8279
Other providers in Crestview, FL
- Amedisys Florida, LLC
- Naana W Anakwah
- Amy Southerland Anderson
- Cristina Faith Anderson
- Kallie Anderson
- Misti D Anderson
- Thomas Randall Anderson
- Eva Andrews
- Anesthesia and Pain Consultants, PA
- Julie Michelle Ansley
All providers in Crestview, FL · Speech-Language Pathologist in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.