Provider Demographics
NPI:1437660941
Name:SPEECH4KIDS OF GAINESVILLE LLC
Entity Type:Organization
Organization Name:SPEECH4KIDS OF GAINESVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:MURPHY
Authorized Official - Last Name:VAUDREUIL
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:352-514-7935
Mailing Address - Street 1:14250 SW 4TH PL
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-3393
Mailing Address - Country:US
Mailing Address - Phone:352-514-7935
Mailing Address - Fax:
Practice Address - Street 1:14250 SW 4TH PL
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669-3393
Practice Address - Country:US
Practice Address - Phone:352-514-7935
Practice Address - Fax:352-514-7935
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-24
Last Update Date:2017-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5126235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty