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Organization
MOTOR MOUTH SPEECH AND FEEDING THERAPY LLC
Active
Organization
MOTOR MOUTH SPEECH AND FEEDING THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BROOKE LANE WILSON SLP-CCC (OWNER, SPEECH PATHOLOGIST)
(321) 230-3800
Entity
Organization
Contact information
Practice address
110 SOLANA RD, PONTE VEDRA BEACH, FL 32082
(321) 230-3800
Mailing address
110 SOLANA RD, PONTE VEDRA BEACH, FL 32082-5206
(321) 230-3800
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA11587
FL
Other
Enumeration date
06/15/2017
Last updated
08/14/2018
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