Theisen, Justine Taylor

Theisen, Justine Taylor is an individual health care provider with primary practice located at 5811 Bamboo Drive , Fort Pierce FL 34982-3758. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Theisen, Justine Taylor can be contacted via phone (772) 242-3187.

Contact Information

Primary practice address
5811 Bamboo Drive Fort Pierce FL 34982-3758
Phone: (772) 242-3187
Fax: (772) 494-7262
Website:
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Health care specialties

SpecialtyCodeLicense #State
Speech, Language and Hearing Service Providers / Speech-Language Pathologist 235Z00000X SA10918 Florida

Profile Details

NPI number 1598056707
LBN Legal business name Theisen, Justine Taylor
Credentials M.A. CCC-SLP
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 21st, 2011
Last updated Aug 30th, 2016 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598056707 NPPES
Florida MEDICAID 011847300

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