Provider Demographics
NPI:1386521532
Name:NIA SPEECH THERAPY AND CONSULTING, LLC
Entity type:Organization
Organization Name:NIA SPEECH THERAPY AND CONSULTING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MGR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NIKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MED, CCC-SLP
Authorized Official - Phone:321-426-1645
Mailing Address - Street 1:3425 BAYSIDE LAKES BLVD SE
Mailing Address - Street 2:STE 103 PMB 1155
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32909
Mailing Address - Country:US
Mailing Address - Phone:321-426-1645
Mailing Address - Fax:
Practice Address - Street 1:545 KYLAR DR NW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-6806
Practice Address - Country:US
Practice Address - Phone:321-426-1645
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty