Provider Demographics
NPI:1710351887
Name:MIAMI SPEECH & SWALLOWING CENTER, INC.
Entity Type:Organization
Organization Name:MIAMI SPEECH & SWALLOWING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:786-512-4793
Mailing Address - Street 1:11890 SW 8TH ST STE 514
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-1701
Mailing Address - Country:US
Mailing Address - Phone:786-512-4793
Mailing Address - Fax:
Practice Address - Street 1:11890 SW 8TH ST STE 514
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-1701
Practice Address - Country:US
Practice Address - Phone:786-512-4793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-30
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6156261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech