Provider Demographics
NPI:1194292425
Name:HARRISON, JOCELYN M (MS, CF-SLP)
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:M
Last Name:HARRISON
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:JOCELYN
Other - Middle Name:G
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9950 S OCEAN DR APT 1805
Mailing Address - Street 2:
Mailing Address - City:JENSEN BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:34957-2437
Mailing Address - Country:US
Mailing Address - Phone:954-802-1272
Mailing Address - Fax:
Practice Address - Street 1:1483 SW BOUGAINVILLEA AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7302
Practice Address - Country:US
Practice Address - Phone:772-336-6928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSZ8761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist