Provider Demographics
NPI:1275981599
Name:GISELLE SPEECH AND LANGUAGE THERAPY, LLC.
Entity Type:Organization
Organization Name:GISELLE SPEECH AND LANGUAGE THERAPY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LILA
Authorized Official - Middle Name:GISELLE
Authorized Official - Last Name:PAREDES
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:917-622-5417
Mailing Address - Street 1:1723 SW 2ND AVE APT 1202
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33129-2164
Mailing Address - Country:US
Mailing Address - Phone:917-622-5417
Mailing Address - Fax:305-397-1181
Practice Address - Street 1:1723 SW 2ND AVE APT 1202
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33129
Practice Address - Country:US
Practice Address - Phone:917-622-5417
Practice Address - Fax:305-397-1181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-26
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 12058235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty