Provider Demographics
NPI:1104447945
Name:DAWAL, JOCELYN (MED, SLP-CCC)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:
Last Name:DAWAL
Suffix:
Gender:F
Credentials:MED, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7580 CAMERON CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-5658
Mailing Address - Country:US
Mailing Address - Phone:404-922-1135
Mailing Address - Fax:
Practice Address - Street 1:15071 SHELL POINT BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-1639
Practice Address - Country:US
Practice Address - Phone:239-415-5432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-04
Last Update Date:2020-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA17056235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist