1043543226 NPI number — SPECTRUM SPEECH AND LANGUAGE SERVICES, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043543226 NPI number — SPECTRUM SPEECH AND LANGUAGE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPECTRUM SPEECH AND LANGUAGE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043543226
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12785 W. FOREST HILL BLVD
Provider Second Line Business Mailing Address:
SUITE 8G
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33414-4777
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-753-4998
Provider Business Mailing Address Fax Number:
561-753-4911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12785 W. FOREST HILL BLVD
Provider Second Line Business Practice Location Address:
SUITE 8G
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33414-4777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-753-4998
Provider Business Practice Location Address Fax Number:
561-753-4911
Provider Enumeration Date:
09/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
EVANS
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
561-753-4998

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001173000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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