Provider Demographics
NPI:1710486048
Name:DEEMAX SPEECH-LANGUAGE THERAPY
Entity Type:Organization
Organization Name:DEEMAX SPEECH-LANGUAGE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.S., CCC-SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-558-4746
Mailing Address - Street 1:12993 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-3108
Mailing Address - Country:US
Mailing Address - Phone:954-558-4746
Mailing Address - Fax:
Practice Address - Street 1:3350 SW 148TH AVE
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-3257
Practice Address - Country:US
Practice Address - Phone:954-558-4746
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-01
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA9053235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty