Individual
ALISA DANELLE DEMICO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
9803 OLD SAINT AUGUSTINE RD, SUITE 7, JACKSONVILLE, FL 32257-8854
(904) 880-9001
(904) 880-9007
Mailing address
6179 ECLIPSE CIR, JACKSONVILLE, FL 32258-8434
(904) 534-8111
(904) 880-9007
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA4664
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
884233700
—
FL
Enumeration date
06/29/2006
Last updated
12/19/2012
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