Organization
TIDALHEALTH PEDIATRIC DEVELOPMENT AND THERAPY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAZMINE MAREE HOLLINS (CREDENTIALING SPECIALIST)
(704) 799-6824
Entity
Organization
Contact information
Practice address
30265 COMMERCE DR UNIT 204, MILLSBORO, DE 19966-3595
(443) 978-6020
Mailing address
30265 COMMERCE DR UNIT 204, MILLSBORO, DE 19966-3595
(443) 978-6020
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
—
—
Other
Enumeration date
06/05/2025
Last updated
06/05/2025
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