Individual
MRS. ELIZABETH JANE O'GRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS CCC-SLP
Contact information
Practice address
11512 LAKE MEAD AVE, SUITE 203, JACKSONVILLE, FL 32256-9680
(904) 652-5408
(904) 997-6478
Mailing address
7955 MOUNT RANIER DR, JACKSONVILLE, FL 32256-2906
(904) 652-5408
(904) 997-6478
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA5968
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
043816841
TAX IDENTIFICATION NUMBER
—
Enumeration date
09/03/2006
Last updated
09/29/2008
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