Provider Demographics
NPI:1275222796
Name:ORLANDO SPEECH CLINIC, LLC
Entity Type:Organization
Organization Name:ORLANDO SPEECH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:IVANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:407-883-3295
Mailing Address - Street 1:646 W SMITH ST UNIT 558
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5384
Mailing Address - Country:US
Mailing Address - Phone:407-883-3295
Mailing Address - Fax:
Practice Address - Street 1:646 W SMITH ST UNIT 558
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5384
Practice Address - Country:US
Practice Address - Phone:407-883-3295
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1518352475Medicaid