Provider Demographics
NPI:1952069882
Name:PROCLAIM COMMUNICATION AND REHABILITATION SERVICES, LLC
Entity Type:Organization
Organization Name:PROCLAIM COMMUNICATION AND REHABILITATION SERVICES, LLC
Other - Org Name:PROCLAIM COMMUNICATION AND REHABILITATION SERVICES, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MARISCAL
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:321-209-0171
Mailing Address - Street 1:405 GUINEVERE DR
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32908-6431
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4680 LIPSCOMB ST NE STE 4
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32905-2984
Practice Address - Country:US
Practice Address - Phone:321-209-0171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty