Provider Demographics
NPI:1518592088
Name:SPEECH PATHOLOGY AND REHABILIATION CENTER
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY AND REHABILIATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RUIZ
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:352-682-6195
Mailing Address - Street 1:2208 LOBLOLLY BAY ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-9562
Mailing Address - Country:US
Mailing Address - Phone:352-682-6195
Mailing Address - Fax:
Practice Address - Street 1:2208 LOBLOLLY BAY ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-9562
Practice Address - Country:US
Practice Address - Phone:352-682-6195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-05
Last Update Date:2020-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty