Provider Demographics
| NPI: | 1326316696 |
|---|---|
| Name: | SPEECH CONNECTION LLC |
| Entity type: | Organization |
| Organization Name: | SPEECH CONNECTION LLC |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | OWNER/MANAGER |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | TINA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | PORRECA |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MS, CCC-SLP |
| Authorized Official - Phone: | 727-631-2466 |
| Mailing Address - Street 1: | 16697 SHELL BAY DR |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LAND O LAKES |
| Mailing Address - State: | FL |
| Mailing Address - Zip Code: | 34638-5749 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 727-631-2466 |
| Mailing Address - Fax: | 813-345-2896 |
| Practice Address - Street 1: | 16697 SHELL BAY DR BAY |
| Practice Address - Street 2: | |
| Practice Address - City: | LAND O LAKES |
| Practice Address - State: | FL |
| Practice Address - Zip Code: | 34638-5749 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 727-631-2466 |
| Practice Address - Fax: | 813-345-2896 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2011-12-01 |
| Last Update Date: | 2023-12-08 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| FL | SA8085 | 222Q00000X, 252Y00000X, 235Z00000X |
| FL | 224Z00000X, 225100000X, 225200000X, 225X00000X | |
| SA8085 | 2355S0801X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty | |
| No | 222Q00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Developmental Therapist | Group - Multi-Specialty | |
| No | 224Z00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Group - Multi-Specialty | |
| No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
| No | 225200000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapy Assistant | Group - Multi-Specialty | |
| No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
| No | 2355S0801X | Speech, Language and Hearing Service Providers | Specialist/Technologist | Speech-Language Assistant | Group - Multi-Specialty |
| No | 252Y00000X | Agencies | Early Intervention Provider Agency | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| FL | 009661900 | Medicaid | |
| FL | 013550300 | Medicaid | |
| FL | 010868800 | Medicaid | |
| FL | FT922A | Medicare UPIN |