Organization
LUNA THERAPY SERVICES LLC
Active
Other names
Luna Therapy Services
Organization subpart
No
Provider details
NPI number
Authorized official
LESLEY SUMMERS MAT, M.A., CCC-SLP (OWNER)
(904) 431-7276
Entity
Organization
Contact information
Practice address
1419 HUBBARD ST, JACKSONVILLE, FL 32206-4533
(904) 431-7276
(904) 456-0838
Mailing address
1419 HUBBARD ST, JACKSONVILLE, FL 32206-4533
(904) 431-7276
(904) 456-0838
Taxonomy
Speciality
Code
Description
License number
State
261QH0700X
Hearing and Speech Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103131600
—
FL
01
—
14508875
CAQH
FL
01
—
SA18358
FLORIDA DOH
FL
Enumeration date
07/19/2021
Last updated
07/19/2021
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