Organization
FRESH START SPEECH THERAPY SERVICES LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KHALILAH MIGNON MARQUES M.A. CCC-SLP (DIRECTOR, MANAGER)
(904) 652-6165
Entity
Organization
Contact information
Practice address
9957 MOORINGS DR STE 301, JACKSONVILLE, FL 32257-2415
(904) 652-6165
(833) 241-4607
Mailing address
9957 MOORINGS DR STE 301, JACKSONVILLE, FL 32257-2415
(904) 652-6165
(833) 241-4607
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
—
—
2355S0801X
Speech-Language Assistant
—
—
235Z00000X
Speech-Language Pathologist
—
—
261Q00000X
Clinic/Center
Primary
—
—
261QH0700X
Hearing and Speech Clinic/Center
—
—
Other
Enumeration date
04/07/2017
Last updated
05/30/2023
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