Provider Demographics
NPI:1306633664
Name:SEYMOUR, RITA MICHELLE (MA CCC/SLP)
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MICHELLE
Last Name:SEYMOUR
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 BUCKTAIL AVE
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-6180
Mailing Address - Country:US
Mailing Address - Phone:352-222-6031
Mailing Address - Fax:
Practice Address - Street 1:9601 SOUTHBROOK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-0601
Practice Address - Country:US
Practice Address - Phone:904-641-7501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-21
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty