Provider Demographics
NPI:1972259604
Name:CORRECTIVE SPEECH AND LANGUAGE THERAPY, INC.
Entity Type:Organization
Organization Name:CORRECTIVE SPEECH AND LANGUAGE THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHOCKLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP, CAS
Authorized Official - Phone:407-857-6285
Mailing Address - Street 1:14055 TOWN LOOP BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6106
Mailing Address - Country:US
Mailing Address - Phone:407-857-6285
Mailing Address - Fax:
Practice Address - Street 1:14055 TOWN LOOP BLVD STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6106
Practice Address - Country:US
Practice Address - Phone:407-857-6285
Practice Address - Fax:407-857-9566
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORRECTIVE SPEECH AND LANGUAGE THERAPY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL812053600Medicaid