Unknown Individual – Speech-Language Pathologist, NPI 1063621407

Unknown Individual is a healthcare provider. based in Bonita springs, Florida. specializing in Speech-Language Pathologist. They hold a License No. SA 4280 (FL). The NPI Number for Unknown Individual is 1063621407

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1063621407
Phone
(239) 989-9846
Address
28881 BERMUDA LAGO CT
Deactivation Date
26 April 2022
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • Bermuda Largo Court, Bermuda Lago Condos, Bonita Springs, Lee County, Florida, 13434, United States

    APT 104

    BONITA SPRINGS, FL 341346321

    Phone: (239) 989-9846

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 34134)

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Reviews

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Frequently asked questions

How is Unknown Individual identified in CMS data?
CMS-hosted NPPES data lists Unknown Individual with NPI 1063621407.
What dates should I check for Unknown Individual's activity?
We display what the registry publishes: Unknown Individual appears inactive there.
What is Unknown Individual's primary classification?
Speech-Language Pathologist is the headline specialty for Unknown Individual here. Clinical services aligned with this taxonomy classification.
What address line appears for Unknown Individual?
Unknown Individual's geographic hint is Bonita Springs, Florida in our summary view.
Is the information about Unknown Individual up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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