Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mrs. Justine Taylor Theisen, MACCC-SLP

Individual provider Speech-Language Pathologist · NPI 1598056707

Mrs. Justine Taylor Theisen, MACCC-SLP is a Speech-Language Pathologist in Fort Pierce, Florida. Licensed in Florida. Registered with an NPI since 2011.

Licensed in
FL
In the registry since
2011

Practice location Address checks out

5811 Bamboo Dr
Fort Pierce, FL 34982-3758
Phone: (772) 242-3187
Fax: (772) 494-7262
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Speech-Language Pathologist (primary) Taxonomy 235Z00000X · Licence SA10918 (FL)

Record details

NPI number1598056707
Entity typeIndividual (Type 1)
GenderFemale
Credentials MACCC-SLP
Sole proprietorNo
NPI enumeratedApril 21, 2011
Last updated in NPPESAugust 30, 2016

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