1821385337 NPI number — LAKE SPEECH AND LANGUAGE EVALUATION AND TREATMENT SERVICES, INC.

Table of content: (NPI 1821385337)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821385337 NPI number — LAKE SPEECH AND LANGUAGE EVALUATION AND TREATMENT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAKE SPEECH AND LANGUAGE EVALUATION AND TREATMENT SERVICES, INC.
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:
1821385337
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
835 7TH ST
Provider Second Line Business Mailing Address:
SUITE 7
Provider Business Mailing Address City Name:
CLERMONT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34711-2190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-432-3998
Provider Business Mailing Address Fax Number:
352-432-3999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
835 7TH ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
CLERMONT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34711-2190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-432-3998
Provider Business Practice Location Address Fax Number:
352-432-3999
Provider Enumeration Date:
07/05/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LOBAINA
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR/ OWNER
Authorized Official Telephone Number:
352-432-3998

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SA8291 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X , with the licence number: SA8887 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 235Z00000X , with the licence number: SA8158 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 002940100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 892301900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003906200 . 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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