Doctor Name: | ANGEL FAY LONGINO |
NPI Number: | 1821470931 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S., CCC-SLP |
License Number: | SA 11727 |
Business Practice Address: | 2600 Grande Isle Dr Apt 13211 Orange City, FL - 327637841 |
Business Phone Number: | 6016684368 |
Business Fax Number: | |
Mailing Address: | 2600 Grande Isle Dr Apt 13211, ORANGE CITY |
State: | FL |
Postal Code: | 327637841 |
Phone Number: | 6016684368 |
Fax Number: | |
NPI Enumeration Date: | 06/25/2015 |
NPI Last Update Date: | 06/25/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | SA 11727 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |