Provider Demographics
NPI:1497586499
Name:PHILLIPS, STORY LOUISE (MS CF-SLP)
Entity type:Individual
Prefix:
First Name:STORY
Middle Name:LOUISE
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 FLAGLER CROSSING DR APT 1438
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-0145
Mailing Address - Country:US
Mailing Address - Phone:407-704-0202
Mailing Address - Fax:
Practice Address - Street 1:207 SAN MARCO AVE
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2762
Practice Address - Country:US
Practice Address - Phone:904-827-2215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist