Provider Demographics
NPI:1538657937
Name:ESCAROSA SPEECH THERAPY LLC
Entity Type:Organization
Organization Name:ESCAROSA SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:TECH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-712-0570
Mailing Address - Street 1:10130 SUGAR CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1688
Mailing Address - Country:US
Mailing Address - Phone:850-797-7106
Mailing Address - Fax:
Practice Address - Street 1:10130 SUGAR CREEK CIR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32514-1688
Practice Address - Country:US
Practice Address - Phone:850-797-7106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11900235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty