Organization
FIRST COAST SPEECH & LANGUAGE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TERESA ELAINE GRADY M.S. CCC-SLP (MANAGING MEMBER)
(904) 631-1525
Entity
Organization
Contact information
Practice address
1571 RIVERTRACE DR, FLEMING ISLAND, FL 32003-7778
(904) 631-1525
(904) 215-1242
Mailing address
1571 RIVERTRACE DR, FLEMING ISLAND, FL 32003-7778
(904) 631-1525
(904) 215-1242
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
235Z00000X
Speech-Language Pathologist
Primary
SA6782
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
888893100
—
FL
Enumeration date
07/14/2009
Last updated
07/14/2009
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