Organization
CARROLLWOOD SPEECH AND SWALLOWING THERAPY, PLLC
Active
Other names
Carrollwood Speech and Swallowing Therapy, Carrollwood Speech & Swallowing Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY STOCKDALE MS, CCC-SLP (OWNER)
(813) 812-4463
Entity
Organization
Contact information
Practice address
14502 N DALE MABRY HWY STE 200, TAMPA, FL 33618-2040
(813) 812-4463
Mailing address
14502 N DALE MABRY HWY STE 200, TAMPA, FL 33618-2040
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018980200
—
FL
01
—
4TM44
BLUE CROSS BLUE SHIELD
FL
Enumeration date
12/19/2017
Last updated
06/16/2018
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