Provider Demographics
NPI:1932697042
Name:BAY AREA SPEECH-LANGUAGE AND COGNITIVE THERAPY LLC
Entity Type:Organization
Organization Name:BAY AREA SPEECH-LANGUAGE AND COGNITIVE THERAPY LLC
Other - Org Name:BAY AREA SPEECH THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIDAS VILARDEBO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:813-956-9564
Mailing Address - Street 1:303 BRYAN RD STE 2
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-5342
Mailing Address - Country:US
Mailing Address - Phone:813-956-9564
Mailing Address - Fax:813-422-7816
Practice Address - Street 1:303 BRYAN RD STE 2
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5342
Practice Address - Country:US
Practice Address - Phone:813-956-9564
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-24
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA14084235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty