Provider Demographics
NPI:1104410893
Name:PERDUE, JOSHUA (CCC'S-SLP)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:PERDUE
Suffix:
Gender:M
Credentials:CCC'S-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1699 SE LYNGATE DR
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-5016
Mailing Address - Country:US
Mailing Address - Phone:772-335-9990
Mailing Address - Fax:
Practice Address - Street 1:1699 SE LYNGATE DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5016
Practice Address - Country:US
Practice Address - Phone:772-335-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA18003235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist