Basic Information
| Provider Information | |||||||||
| NPI: | 1477980183 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FERGUSON | ||||||||
| FirstName: | NEINA | ||||||||
| MiddleName: | F | ||||||||
| NamePrefix: | PROF. | ||||||||
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| Credential: | PH.D., CCC-SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1290 E NINE MILE RD STE B | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325141653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8503840132 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1290 E NINE MILE RD STE B | ||||||||
| Address2: | |||||||||
| City: | PENSACOLA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 325141653 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8508579343 | ||||||||
| FaxNumber: | 8448487557 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2013 | ||||||||
| LastUpdateDate: | 11/26/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 222Q00000X | 6756 | FL | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | 235Z00000X | SA 6756 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 019229200 | 05 | FL | MEDICAID |