Provider Demographics
NPI:1093944811
Name:SPEECH PATHOLOGY OF CORAL GABLES, INC.
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY OF CORAL GABLES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ SPEECH-LANGUAGE PATHOLOG
Authorized Official - Prefix:MRS
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LOPES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:305-774-1788
Mailing Address - Street 1:250 CATALONIA AVE
Mailing Address - Street 2:SUITE 804
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6735
Mailing Address - Country:US
Mailing Address - Phone:305-774-1788
Mailing Address - Fax:305-774-1789
Practice Address - Street 1:603 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-3919
Practice Address - Country:US
Practice Address - Phone:305-774-1788
Practice Address - Fax:305-774-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003542700Medicaid