Provider Demographics
NPI:1184815151
Name:FLORIDA STATE UNIVERSITY
Entity Type:Organization
Organization Name:FLORIDA STATE UNIVERSITY
Other - Org Name:FSU SPEECH & HEARING CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICEADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-644-8554
Mailing Address - Street 1:127 HONORS WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32306-1200
Mailing Address - Country:US
Mailing Address - Phone:850-644-8445
Mailing Address - Fax:
Practice Address - Street 1:127 HONORS WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32306-1200
Practice Address - Country:US
Practice Address - Phone:850-644-8554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========Medicaid