MEDICARE: KIDSPEAK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA5918	FL
2	235Z00000X	Speech-Language Pathologist	SA 7325	FL

General Provider Information

NPI Number	:	1285795807
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDSPEAK

Provider Business Mailing Address
First Line	:	2740 NW 17TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-4402
Country	:	US
Telephone Number	:	954-793-0148
Fax Number	:	954-301-0645

Provider Business Practice Location Address
First Line	:	2740 NW 17TH ST
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-4402
Country	:	US
Telephone Number	:	954-793-0148
Fax Number	:	954-301-0645

Authorized Official
Title or Position	:	OWNER
Name	:	CARROLL FRANICINA WILCOX
Credential	:	M.S. CCC-SLP
Telephone Number	:	954-793-0148

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	08/22/2020

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Directions to “KIDSPEAK ” Practice Location

Language	Start Address	Practice Location

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