Provider Demographics
NPI:1912614488
Name:LIVELY SPEECH AND LANGUAGE THERAPY, LLC
Entity Type:Organization
Organization Name:LIVELY SPEECH AND LANGUAGE THERAPY, LLC
Other - Org Name:LIVELY SPEECH AND LANGUAGE THERAPY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO & FOUNDER
Authorized Official - Prefix:MS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:LIVELY
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:904-729-6759
Mailing Address - Street 1:111 NATURE WALK PKWY UNIT 108
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3065
Mailing Address - Country:US
Mailing Address - Phone:904-729-6759
Mailing Address - Fax:904-490-8549
Practice Address - Street 1:111 NATURE WALK PKWY UNIT 108
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3065
Practice Address - Country:US
Practice Address - Phone:904-729-6759
Practice Address - Fax:904-490-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-03
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLSA12730OtherFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY KIMBERLY KENNELL
FLSA14057OtherFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SARAH LIVELY
FLSA20932OtherFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY MALLORY ABERCROMBIE
FLSA19092OtherFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SONYA OLSEN
FLSA19465OtherFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY JULIANNE TRAUNER
FLSA15493OtherFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY AJA WALKER
FLSA16825OtherFL BOARD OF SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY SAMANTHA REPALONE