Provider Demographics
NPI:1679976898
Name:SPEECH BY THE BEACH, INC.
Entity Type:Organization
Organization Name:SPEECH BY THE BEACH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:BROOKE
Authorized Official - Last Name:NAGELE
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:561-360-6024
Mailing Address - Street 1:388 GOLFVIEW RD APT C
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-3569
Mailing Address - Country:US
Mailing Address - Phone:561-360-6024
Mailing Address - Fax:561-401-0023
Practice Address - Street 1:388 GOLFVIEW RD APT C
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408
Practice Address - Country:US
Practice Address - Phone:561-360-6024
Practice Address - Fax:561-401-0023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2018-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA11627235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023552700Medicaid