Provider Demographics
NPI:1568950004
Name:SOUTHSHORE BILINGUAL THERAPY INC
Entity Type:Organization
Organization Name:SOUTHSHORE BILINGUAL THERAPY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LUZ
Authorized Official - Middle Name:ESMERALDA
Authorized Official - Last Name:GAONA
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:813-323-5783
Mailing Address - Street 1:906 N US HIGHWAY 41 STE B
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-3544
Mailing Address - Country:US
Mailing Address - Phone:813-323-5783
Mailing Address - Fax:813-303-1074
Practice Address - Street 1:906 N US HIGHWAY 41 STE B
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-3544
Practice Address - Country:US
Practice Address - Phone:813-323-5783
Practice Address - Fax:813-303-1074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-30
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13354235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty