Organization
GREEN APPLE THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHLEEN R SHEPARD CCC/SLP (OWNER)
(352) 256-5072
Entity
Organization
Contact information
Practice address
23005 NW 11TH RD, NEWBERRY, FL 32669-1911
(352) 256-5072
Mailing address
PO BOX 359064, GAINESVILLE, FL 32635-9016
(352) 256-5072
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA9491
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001158700
—
FL
Enumeration date
01/30/2013
Last updated
01/30/2013
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