Provider Demographics
NPI:1083881783
Name:SPEECH & LANGUAGE PATHOLOGY OF C. FL., INC
Entity Type:Organization
Organization Name:SPEECH & LANGUAGE PATHOLOGY OF C. FL., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/SP-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAILA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:407-291-9393
Mailing Address - Street 1:PO BOX 291
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32790-0291
Mailing Address - Country:US
Mailing Address - Phone:407-291-9393
Mailing Address - Fax:407-291-9699
Practice Address - Street 1:540 E HORATIO AVE STE 215
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-7314
Practice Address - Country:US
Practice Address - Phone:407-291-9393
Practice Address - Fax:407-291-9699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1882235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty