Organization
FAME SPEECH AND MYO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXA STUBENRAUCH MS CCC-SLP (SPEECH LANGUAGE PATHOLOGIST)
(717) 875-0962
Entity
Organization
Contact information
Practice address
13490 GRAN BAY PKWY APT 732, JACKSONVILLE, FL 32258-7439
(717) 875-0962
Mailing address
178 VISTA GRANDE DR, PONTE VEDRA BEACH, FL 32082-1754
(717) 875-0962
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
02/16/2022
Last updated
11/04/2022
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