Organization
FOUNDATIONS: SPEECH, LANGUAGE AND LEARNING SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA C CLARK M.S., CCC-SLP (OWNER/ SPEECH LANGUAGE PATHOLOGIST)
(904) 397-0004
Entity
Organization
Contact information
Practice address
11787 BLUEBERRY LN, MACCLENNY, FL 32063-4163
(904) 397-0004
Mailing address
11787 BLUEBERRY LN, MACCLENNY, FL 32063-4163
(904) 397-0004
Taxonomy
Speciality
Code
Description
License number
State
252Y00000X
Early Intervention Provider Agency
Primary
SA5772
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001229500
—
FL
05
—
001229700
—
FL
01
—
1811123060
INDIVIDUAL NPI NUMBER
FL
Enumeration date
12/05/2009
Last updated
12/05/2009
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