Provider Demographics
NPI:1962916551
Name:COMMUNICATION STATION & CONSULTING, LLC
Entity type:Organization
Organization Name:COMMUNICATION STATION & CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:SIMS
Authorized Official - Last Name:WAHLQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:850-643-1979
Mailing Address - Street 1:11899 NW LAKE MYSTIC DUGGAR RD
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-3929
Mailing Address - Country:US
Mailing Address - Phone:850-643-1979
Mailing Address - Fax:
Practice Address - Street 1:10659 NW STATE ROAD 20
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-3441
Practice Address - Country:US
Practice Address - Phone:850-643-1979
Practice Address - Fax:850-643-1293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-19
Last Update Date:2017-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11635235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016774900Medicaid