Organization
NEW LIFE SPEECH THERAPY
Active
Organization
NEW LIFE SPEECH THERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURIE BURNETT M.S. CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(321) 917-0297
Entity
Organization
Contact information
Practice address
1450 GLEN HAVEN DR, MERRITT ISLAND, FL 32952-5821
(321) 917-0297
Mailing address
1450 GLEN HAVEN DR, MERRITT ISLAND, FL 32952-5821
(321) 917-0297
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
SA16056
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003821489
NPI
—
01
—
SA16056
STATE LICENSE
FL
Enumeration date
03/28/2018
Last updated
03/28/2018
Update your record
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