Provider Demographics
NPI:1750893491
Name:HABLA CONMIGO SPEECH THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:HABLA CONMIGO SPEECH THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANILDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSUNFISAN
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD
Authorized Official - Phone:954-557-6632
Mailing Address - Street 1:4500 N STATE ROAD 7 STE 214
Mailing Address - Street 2:
Mailing Address - City:LAUDERDALE LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33319-5882
Mailing Address - Country:US
Mailing Address - Phone:954-533-2226
Mailing Address - Fax:954-765-6708
Practice Address - Street 1:4500 N STATE ROAD 7 STE 214
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33319
Practice Address - Country:US
Practice Address - Phone:954-533-2226
Practice Address - Fax:954-765-6708
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA15837261Q00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL023738500Medicaid