Provider Demographics
NPI:1487134128
Name:MAPP CORPORATION OF POLK COUNTY
Entity type:Organization
Organization Name:MAPP CORPORATION OF POLK COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:HAS, BC-HIS
Authorized Official - Phone:863-687-8420
Mailing Address - Street 1:510 E CRAWFORD ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33805-3732
Mailing Address - Country:US
Mailing Address - Phone:863-687-8420
Mailing Address - Fax:
Practice Address - Street 1:510 E CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-3732
Practice Address - Country:US
Practice Address - Phone:863-687-8420
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAPP CORPORATION OF POLK COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAS4860237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL09204Medicaid