Provider Demographics
NPI:1376925172
Name:CAPITAL SPEECH AND LANGUAGE THERAPY SERVICES LLC
Entity Type:Organization
Organization Name:CAPITAL SPEECH AND LANGUAGE THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBYN
Authorized Official - Middle Name:A
Authorized Official - Last Name:HILLISON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:850-264-7599
Mailing Address - Street 1:6497 VELDA DAIRY RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6310
Mailing Address - Country:US
Mailing Address - Phone:850-264-7599
Mailing Address - Fax:866-533-3994
Practice Address - Street 1:6497 VELDA DAIRY RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32309-6310
Practice Address - Country:US
Practice Address - Phone:850-264-7599
Practice Address - Fax:866-533-3994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-29
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10045235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty