Organization
BETH INGRAM THERAPY SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE RETSKY M.S. CF-SLP (SPEECH LANGUAGE PATHOLOGIST)
(757) 386-3394
Entity
Organization
Contact information
Practice address
2111 W SWANN AVE STE 100, TAMPA, FL 33606-2478
(757) 386-3394
Mailing address
10598 ORANGE BLOSSOM LN, SEMINOLE, FL 33772-7503
(757) 386-3394
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
SZ9227
PROVISIONAL LICENSE FOR SPEECH LANGUAGE PATHOLOGIST
FL
Enumeration date
08/27/2019
Last updated
08/27/2019
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