Provider Demographics
NPI:1891161220
Name:SPEAK, MOVE, GROW, LLC
Entity Type:Organization
Organization Name:SPEAK, MOVE, GROW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORELLE
Authorized Official - Middle Name:B
Authorized Official - Last Name:VASCOS-PAGES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:305-323-2364
Mailing Address - Street 1:7765 SW 142ND ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33158-1514
Mailing Address - Country:US
Mailing Address - Phone:305-323-2364
Mailing Address - Fax:
Practice Address - Street 1:7765 SW 142ND ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33158-1514
Practice Address - Country:US
Practice Address - Phone:305-323-2364
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 9572261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech