Individual
MRS. GEANINE L DETTMORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A.,CCC-SLP
Contact information
Practice address
1119 SHADOWBROOK TRL, WINTER SPRINGS, FL 32708-6323
(407) 247-8291
Mailing address
1119 SHADOWBROOK TRL, WINTER SPRINGS, FL 32708-6323
(407) 247-8291
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA 7685
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
889 365 900
—
FL
Enumeration date
05/09/2006
Last updated
02/23/2009
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