Provider Demographics
NPI:1346213576
Name:SPECIALIZED SPEECH CENTER, INC.
Entity Type:Organization
Organization Name:SPECIALIZED SPEECH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMBASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MS/CCC-SLP
Authorized Official - Phone:954-442-9422
Mailing Address - Street 1:3335 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-2200
Mailing Address - Country:US
Mailing Address - Phone:954-442-9422
Mailing Address - Fax:954-442-9150
Practice Address - Street 1:3335 N UNIVERSITY DR
Practice Address - Street 2:SUITE 5
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-2200
Practice Address - Country:US
Practice Address - Phone:954-442-9422
Practice Address - Fax:954-442-9150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOT11451225X00000X
FLSA4906235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLS1795OtherBC/BS OF FL
FL884449600Medicaid
FL830087900Medicaid
FL883785600Medicaid
FL2015424OtherAETNA
FL884371600Medicaid
FLT0757OtherBC/BS