Provider Demographics
NPI:1447800867
Name:DISTRICT SPEECH AND SWALLOW REHAB
Entity Type:Organization
Organization Name:DISTRICT SPEECH AND SWALLOW REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MIKI
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:SHIBATA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:904-441-0302
Mailing Address - Street 1:200 Q ST NE APT 2237
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-2390
Mailing Address - Country:US
Mailing Address - Phone:904-441-0302
Mailing Address - Fax:202-217-2104
Practice Address - Street 1:200 Q ST NE APT 2237
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-2390
Practice Address - Country:US
Practice Address - Phone:904-441-0302
Practice Address - Fax:202-217-2104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-17
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty