1639690217 NPI number — SIMPLY SPEECH FORT WALTON BEACH LLC

Table of content: (NPI 1639690217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639690217 NPI number — SIMPLY SPEECH FORT WALTON BEACH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIMPLY SPEECH FORT WALTON BEACH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1639690217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/04/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 POCAHONTAS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WALTON BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32547-3283
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
850-803-9285
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
118 TRUXTON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WALTON BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32547-2461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-803-9285
Provider Business Practice Location Address Fax Number:
850-664-7691
Provider Enumeration Date:
07/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
BAUMAN
Authorized Official First Name:
HEATHER
Authorized Official Middle Name:
PEARL
Authorized Official Title or Position:
OWNER/SOLE MEMBER
Authorized Official Telephone Number:
850-803-9285

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA14802 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com