Provider Demographics
NPI:1821385337
Name:LAKE SPEECH AND LANGUAGE EVALUATION AND TREATMENT SERVICES, INC.
Entity Type:Organization
Organization Name:LAKE SPEECH AND LANGUAGE EVALUATION AND TREATMENT SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:S
Authorized Official - Last Name:LOBAINA
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:352-432-3998
Mailing Address - Street 1:835 7TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2190
Mailing Address - Country:US
Mailing Address - Phone:352-432-3998
Mailing Address - Fax:352-432-3999
Practice Address - Street 1:835 7TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2190
Practice Address - Country:US
Practice Address - Phone:352-432-3998
Practice Address - Fax:352-432-3999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA8291235Z00000X
FLSA8887235Z00000X
FLSA8158235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002940100Medicaid
FL892301900Medicaid