Provider Demographics
NPI:1518289024
Name:SPEECH ABILITIES THERAPY CORP.
Entity Type:Organization
Organization Name:SPEECH ABILITIES THERAPY CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROUCO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:786-431-5140
Mailing Address - Street 1:5580 W 16TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-2189
Mailing Address - Country:US
Mailing Address - Phone:786-431-5140
Mailing Address - Fax:305-827-0953
Practice Address - Street 1:5580 W 16TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2189
Practice Address - Country:US
Practice Address - Phone:786-431-5140
Practice Address - Fax:305-827-0953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA6196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL892896700Medicaid