Provider Demographics
NPI:1760584825
Name:SPEECH PATHOLOGY CONSULTANT GROUP, INC.
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY CONSULTANT GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:PASSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-437-0029
Mailing Address - Street 1:18459 PINES BLVD
Mailing Address - Street 2:124
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1400
Mailing Address - Country:US
Mailing Address - Phone:954-437-0029
Mailing Address - Fax:954-437-0029
Practice Address - Street 1:18459 PINES BLVD
Practice Address - Street 2:124
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1400
Practice Address - Country:US
Practice Address - Phone:954-437-0029
Practice Address - Fax:954-437-0029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2148235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty