Provider Demographics
NPI:1952099756
Name:LOGOS COMMUNICATION THERAPY SERVICES, LLC
Entity Type:Organization
Organization Name:LOGOS COMMUNICATION THERAPY SERVICES, LLC
Other - Org Name:THE SPEECH POD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ENRI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FORT
Authorized Official - Suffix:
Authorized Official - Credentials:MS,CCC-SLP
Authorized Official - Phone:850-830-3314
Mailing Address - Street 1:106 BLACK BEAR CIR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-1202
Mailing Address - Country:US
Mailing Address - Phone:850-904-0355
Mailing Address - Fax:850-904-0355
Practice Address - Street 1:11 RACETRACK RD NE STE B4
Practice Address - Street 2:
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32547-1861
Practice Address - Country:US
Practice Address - Phone:850-830-3314
Practice Address - Fax:850-904-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-28
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No252Y00000XAgenciesEarly Intervention Provider AgencyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118480700Medicaid
FL117493600Medicaid