Provider Demographics
NPI:1376300947
Name:CREATIVE SPEECH SOLUTIONS
Entity Type:Organization
Organization Name:CREATIVE SPEECH SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DEVELOPMENTAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CAMPUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-205-8186
Mailing Address - Street 1:1836 N CRYSTAL LAKE DR
Mailing Address - Street 2:UNIT 72
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801
Mailing Address - Country:US
Mailing Address - Phone:708-205-8186
Mailing Address - Fax:
Practice Address - Street 1:1836 N CRYSTAL LAKE DR
Practice Address - Street 2:UNIT 72
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801
Practice Address - Country:US
Practice Address - Phone:708-205-8186
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental TherapistGroup - Single Specialty