Provider Demographics
NPI:1700512183
Name:START PEDIATRIC SPEECH THERAPY, LLC
Entity Type:Organization
Organization Name:START PEDIATRIC SPEECH THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GISELLE
Authorized Official - Middle Name:C
Authorized Official - Last Name:AQUINO
Authorized Official - Suffix:
Authorized Official - Credentials:MSCCC-SLP
Authorized Official - Phone:561-385-1430
Mailing Address - Street 1:11672 TURNSTONE DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-5846
Mailing Address - Country:US
Mailing Address - Phone:561-385-1430
Mailing Address - Fax:
Practice Address - Street 1:11672 TURNSTONE DR
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5846
Practice Address - Country:US
Practice Address - Phone:561-385-1430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-27
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty