Provider Demographics
NPI:1013277318
Name:ASSOCIATES IN SPEECH-LANGUAGE PATHOLOGY, LLC
Entity Type:Organization
Organization Name:ASSOCIATES IN SPEECH-LANGUAGE PATHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:321-241-4816
Mailing Address - Street 1:2226 SARNO RD
Mailing Address - Street 2:#101
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-3087
Mailing Address - Country:US
Mailing Address - Phone:321-241-4816
Mailing Address - Fax:321-241-4817
Practice Address - Street 1:2226 SARNO RD
Practice Address - Street 2:#101
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-3087
Practice Address - Country:US
Practice Address - Phone:321-241-4816
Practice Address - Fax:321-241-4817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-21
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA10305235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004780400Medicaid
FLHB746AMedicare UPIN