Provider Demographics
NPI:1720135718
Name:SPEECH PATHOLOGY AND EDUCATIONAL CENTER INC
Entity Type:Organization
Organization Name:SPEECH PATHOLOGY AND EDUCATIONAL CENTER INC
Other - Org Name:SPEC
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:
Authorized Official - Last Name:SUAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC
Authorized Official - Phone:305-266-5353
Mailing Address - Street 1:8510 SW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-4053
Mailing Address - Country:US
Mailing Address - Phone:305-266-5353
Mailing Address - Fax:305-266-6550
Practice Address - Street 1:8510 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4053
Practice Address - Country:US
Practice Address - Phone:305-266-5353
Practice Address - Fax:305-266-6550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-04
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 1502235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102170OtherAVMED PROVIDER NUMBER
FL38616OtherNHP PROVIDER NUMBER
FL4279OtherSOUTH CARE PPO
FL237488OtherAMERIGROUP PROVIDER NO.
FL810891900Medicaid
FL4602011OtherUHC PROVIDER NUMBER
FL880762100Medicaid
FL880762101Medicaid
FLS0638OtherBCBS BILLING NUMBER
FL683277OtherACN GROUP
FL2692772001OtherCIGNA HEALTH CARE
FL886038600Medicaid
FL4279OtherSOUTH CARE PPO
FL880762100Medicaid