Provider Demographics
NPI:1326619628
Name:SPEECH AND OCCUPATIONAL SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SPEECH AND OCCUPATIONAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-399-6556
Mailing Address - Street 1:1201 WINTER GARDEN VINELAND RD STE 10
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4380
Mailing Address - Country:US
Mailing Address - Phone:407-399-6556
Mailing Address - Fax:407-654-5829
Practice Address - Street 1:1599 TROPICAL CT
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4340
Practice Address - Country:US
Practice Address - Phone:407-399-6556
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL104945700Medicaid