Provider Demographics
NPI:1285637892
Name:AUDIOLOGY AND SPEECH PATHOLOGY, INC
Entity Type:Organization
Organization Name:AUDIOLOGY AND SPEECH PATHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRANT
Authorized Official - Suffix:
Authorized Official - Credentials:AUD
Authorized Official - Phone:561-649-4006
Mailing Address - Street 1:3540 FOREST HILL BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5878
Mailing Address - Country:US
Mailing Address - Phone:561-649-4006
Mailing Address - Fax:561-969-6621
Practice Address - Street 1:3540 FOREST HILL BLVD
Practice Address - Street 2:STE 205
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5878
Practice Address - Country:US
Practice Address - Phone:561-649-4006
Practice Address - Fax:561-969-6621
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHLAND HEARING CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-05-27
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600037108Medicaid
FLT0938OtherBCBS
FL600037110Medicaid
FL600037100Medicaid
FLK6335Medicare ID - Type Unspecified