Basic Information
| Provider Information | |||||||||
| NPI: | 1629303219 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THE APHASIA CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6830 CENTRAL AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278232529 | ||||||||
| FaxNumber: | 7272897062 | ||||||||
| Practice Location | |||||||||
| Address1: | 6830 CENTRAL AVE | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337071208 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278232529 | ||||||||
| FaxNumber: | 7272897062 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/15/2009 | ||||||||
| LastUpdateDate: | 02/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | BARTELS-TOBIN | ||||||||
| AuthorizedOfficialFirstName: | LORI | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 7278232529 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA7494 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.