Provider Demographics
NPI:1336171826
Name:CENTRAL FLORIDA SPEECH & HEARING CENTER
Entity Type:Organization
Organization Name:CENTRAL FLORIDA SPEECH & HEARING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOLLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-686-3189
Mailing Address - Street 1:3020 LAKELAND HIGHLANDS ROAD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-4338
Mailing Address - Country:US
Mailing Address - Phone:863-686-3189
Mailing Address - Fax:863-682-1348
Practice Address - Street 1:3020 LAKELAND HIGHLANDS ROAD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-4338
Practice Address - Country:US
Practice Address - Phone:863-686-3189
Practice Address - Fax:863-682-1348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL231H00000X, 235Z00000X
231H00000X, 2355A2700X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No2355A2700XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistAudiology AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL085626601Medicaid
FL672202496OtherMEDWAIVER
FL244OtherATA
FL085626600Medicaid
FL206030OtherAMERIGROUP
FLJ0153OtherBLUE CROSS BLUE SHIELD
FL10628201OtherCITNUS CARE
S0073Medicare UPIN
FL8031Medicare ID - Type UnspecifiedRAILROAD