Provider Demographics
NPI:1508295155
Name:SPEECH INNOVATIONS OF CENTRAL FLORIDA LLC
Entity Type:Organization
Organization Name:SPEECH INNOVATIONS OF CENTRAL FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:KATHERINE
Authorized Official - Last Name:AUTENRIETH
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:407-694-3603
Mailing Address - Street 1:2080 W EAU GALLIE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3185
Mailing Address - Country:US
Mailing Address - Phone:407-694-3603
Mailing Address - Fax:321-296-7130
Practice Address - Street 1:253 PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765
Practice Address - Country:US
Practice Address - Phone:407-694-3603
Practice Address - Fax:321-296-7130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004185100Medicaid
FL009856500Medicaid