Provider Demographics
NPI:1407084825
Name:SOUTH FLORIDA SPEECH AND LANGUAGE SERVICES, INC,
Entity Type:Organization
Organization Name:SOUTH FLORIDA SPEECH AND LANGUAGE SERVICES, INC,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARI
Authorized Official - Middle Name:L
Authorized Official - Last Name:DEWEESE
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:561-502-8487
Mailing Address - Street 1:5365 HUNTERS CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-1713
Mailing Address - Country:US
Mailing Address - Phone:561-502-8487
Mailing Address - Fax:561-642-9397
Practice Address - Street 1:504 SW 20TH ST
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-4621
Practice Address - Country:US
Practice Address - Phone:561-502-8487
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-24
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6981235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888150200Medicaid
FL888288600Medicaid