Provider Demographics
NPI:1134231848
Name:SPEECH AND LANGUAGE CENTER, LLC
Entity type:Organization
Organization Name:SPEECH AND LANGUAGE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:850-664-7799
Mailing Address - Street 1:133A STAFF DR NE
Mailing Address - Street 2:
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5050
Mailing Address - Country:US
Mailing Address - Phone:850-664-7799
Mailing Address - Fax:
Practice Address - Street 1:2039 JESSICA WAY
Practice Address - Street 2:
Practice Address - City:NAVARRE
Practice Address - State:FL
Practice Address - Zip Code:32566-2947
Practice Address - Country:US
Practice Address - Phone:850-217-8793
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty