Provider Demographics
NPI:1063824597
Name:EVA LUNA ODONNELL SPEECH & LANGUAGE SERVICES, INC.
Entity Type:Organization
Organization Name:EVA LUNA ODONNELL SPEECH & LANGUAGE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVA
Authorized Official - Middle Name:L
Authorized Official - Last Name:ODONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-240-4382
Mailing Address - Street 1:357 SW COCONUT KEY WAY
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1907
Mailing Address - Country:US
Mailing Address - Phone:770-240-4382
Mailing Address - Fax:772-344-1706
Practice Address - Street 1:357 SW COCONUT KEY WAY
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1907
Practice Address - Country:US
Practice Address - Phone:770-240-4382
Practice Address - Fax:772-344-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11999235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008003000Medicaid