Organization
MARILYN BOSWORTH, SLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JONATHAN WALTON BOSWORTH HUSBAND (PRESIDENT)
(904) 273-8266
Entity
Organization
Contact information
Practice address
105 ALSACE CT, PONTE VEDRA BEACH, FL 32082-2950
(904) 343-4727
Mailing address
105 ALSACE CT, PONTE VEDRA BEACH, FL 32082-2950
(904) 343-4727
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
SA6123
FL
Other
Enumeration date
08/21/2015
Last updated
08/21/2015
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