Provider Demographics
NPI:1790907145
Name:PROFESSIONAL SPEECH AND HEARING SPECIALISTS, INC
Entity Type:Organization
Organization Name:PROFESSIONAL SPEECH AND HEARING SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:RIERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-351-3977
Mailing Address - Street 1:40 SW 12TH ST
Mailing Address - Street 2:STE 201C
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6521
Mailing Address - Country:US
Mailing Address - Phone:352-351-3977
Mailing Address - Fax:352-351-8642
Practice Address - Street 1:40 SW 12TH ST
Practice Address - Street 2:STE 201C
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6521
Practice Address - Country:US
Practice Address - Phone:352-351-3977
Practice Address - Fax:352-351-8642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
231H00000X
FLSA1494332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL600187400Medicaid
FL600187400Medicaid
FL0868000001Medicare NSC