MEDICARE: YOUNG STRIDES INC

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	SA10251	FL

General Provider Information

NPI Number	:	1518396050
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOUNG STRIDES INC

Provider Business Mailing Address
First Line	:	3599 W LAKE MARY BLVD
Second Line	:	STE 1B4
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3417
Country	:	US
Telephone Number	:	407-416-6963
Fax Number	:

Provider Business Practice Location Address
First Line	:	3599 W LAKE MARY BLVD
Second Line	:	STE 1B4
City	:	LAKE MARY
State	:	FL
Zip	:	32746-3417
Country	:	US
Telephone Number	:	407-416-6963
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NATALIE LAFFERTY
Credential	:
Telephone Number	:	407-416-6963

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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Directions to “YOUNG STRIDES INC ” Practice Location

Language	Start Address	Practice Location

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