Provider Demographics
NPI:1760032353
Name:GROWING UP THERAPY
Entity Type:Organization
Organization Name:GROWING UP THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROPIETOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:SLP, MS,CCC
Authorized Official - Phone:407-624-2509
Mailing Address - Street 1:206 NOVA DR
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33837-2639
Mailing Address - Country:US
Mailing Address - Phone:407-624-2509
Mailing Address - Fax:
Practice Address - Street 1:206 NOVA DR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-2639
Practice Address - Country:US
Practice Address - Phone:407-624-2509
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty