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Organization
THERAPY CONNECTION OF THE TREASURE COAST
Active
Organization
THERAPY CONNECTION OF THE TREASURE COAST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JUSTINE THEISEN M.A. CCC-SLP (OWNER)
(772) 301-1207
Entity
Organization
Contact information
Practice address
549 NW LAKE WHITNEY PL STE 104, PORT ST LUCIE, FL 34986
(772) 301-1207
(772) 301-1255
Mailing address
549 NW LAKE WHITNEY PL STE 104, PORT ST LUCIE, FL 34986-1606
(772) 301-1207
(772) 301-1255
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA10918
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017281400
—
FL
Enumeration date
02/08/2016
Last updated
07/12/2018
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