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Organization
LUNA THERAPY SERVICES LLC
Active
Organization
LUNA THERAPY SERVICES LLC
Active
Other names
Luna Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY SUMMERS MAT, M.A., CCC-SLP (OWNER)
(904) 431-7276
Entity
Organization
Contact information
Practice address
1419 HUBBARD ST, JACKSONVILLE, FL 32206-4533
(904) 431-7276
(904) 456-0838
Mailing address
1419 HUBBARD ST, JACKSONVILLE, FL 32206-4533
(904) 431-7276
(904) 456-0838
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103131600
—
FL
01
—
14508875
CAQH
FL
01
—
SA18358
FLORIDA DOH
FL
Enumeration date
07/19/2021
Last updated
07/19/2021
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