Provider Demographics
NPI:1922266170
Name:SPEECH PATHOLOGY AND EDUCATIONAL CENTERINC
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY AND EDUCATIONAL CENTERINC
Other - Org Name:SPEC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC
Authorized Official - Phone:305-266-5353
Mailing Address - Street 1:8510 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4053
Mailing Address - Country:US
Mailing Address - Phone:305-266-5353
Mailing Address - Fax:
Practice Address - Street 1:8590 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3214
Practice Address - Country:US
Practice Address - Phone:305-266-5353
Practice Address - Fax:305-266-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2020-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1502261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL886038600Medicaid
FL880762100Medicaid
FL810891900Medicaid