Provider Demographics
NPI:1356640106
Name:CLERVAUD SPEECH THERAPY SERVICES INC.
Entity Type:Organization
Organization Name:CLERVAUD SPEECH THERAPY SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:KATIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLERVAUD
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:305-905-8818
Mailing Address - Street 1:7171 SIENNA RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-4313
Mailing Address - Country:US
Mailing Address - Phone:305-905-8818
Mailing Address - Fax:954-533-1481
Practice Address - Street 1:7171 SIENNA RIDGE LN
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-4313
Practice Address - Country:US
Practice Address - Phone:305-905-8818
Practice Address - Fax:954-533-1481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-19
Last Update Date:2011-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10506235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001689000Medicaid