Provider Demographics
NPI:1922358332
Name:CREATIVE SPEECH SOLUTIONS & THERAPY
Entity Type:Organization
Organization Name:CREATIVE SPEECH SOLUTIONS & THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:NIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:PALCESKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-252-4651
Mailing Address - Street 1:PO BOX 781577
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32878-1577
Mailing Address - Country:US
Mailing Address - Phone:321-961-3489
Mailing Address - Fax:
Practice Address - Street 1:447 BELLA VIDA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-6717
Practice Address - Country:US
Practice Address - Phone:321-961-3489
Practice Address - Fax:407-386-6062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-12
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006621500Medicaid