Provider Demographics
NPI:1396969705
Name:FLORIDA SPEECH & LANGUAGE LLC
Entity type:Organization
Organization Name:FLORIDA SPEECH & LANGUAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MALLORI
Authorized Official - Middle Name:JO
Authorized Official - Last Name:ROSSING
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:407-625-9031
Mailing Address - Street 1:4108 LAKE UNDERHILL RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-7080
Mailing Address - Country:US
Mailing Address - Phone:407-625-9031
Mailing Address - Fax:407-896-0214
Practice Address - Street 1:4108 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 304
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-7080
Practice Address - Country:US
Practice Address - Phone:407-625-9031
Practice Address - Fax:407-896-0214
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 6942235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty