Provider Demographics
NPI:1750525945
Name:SOUTH FLORIDA SPEECH AND LEARNING CENTER, INC.
Entity type:Organization
Organization Name:SOUTH FLORIDA SPEECH AND LEARNING CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MACNAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-312-9453
Mailing Address - Street 1:1300 CORAL WAY STE 203
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2934
Mailing Address - Country:US
Mailing Address - Phone:786-312-9453
Mailing Address - Fax:
Practice Address - Street 1:1300 CORAL WAY STE 203
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-2934
Practice Address - Country:US
Practice Address - Phone:786-312-9453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-01
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7343235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL888362900Medicaid