Provider Demographics
NPI:1316192941
Name:JOANNE SPERA SPEECH THERAPY PC
Entity Type:Organization
Organization Name:JOANNE SPERA SPEECH THERAPY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST & LICEN
Authorized Official - Prefix:MS
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:SPERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC/SLP-LCSW
Authorized Official - Phone:917-692-1921
Mailing Address - Street 1:2910 BANCHORY RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-4502
Mailing Address - Country:US
Mailing Address - Phone:917-692-1921
Mailing Address - Fax:321-972-1266
Practice Address - Street 1:3305 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6125
Practice Address - Country:US
Practice Address - Phone:917-692-1921
Practice Address - Fax:407-480-4088
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOANNE SPERA SPEECH THERAPY PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-11-24
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037372-1104100000X
NY011298-1235Z00000X
FLSA10686235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002957700Medicaid