MEDICARE: EUSTIS SPEECH AND LANGUAGE CENTER, 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	SA956	FL

General Provider Information

NPI Number	:	1861605792
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EUSTIS SPEECH AND LANGUAGE CENTER, INC

Provider Business Mailing Address
First Line	:	17521 US HIGHWAY 441
Second Line	:	SUITE 6
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6737
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17521 US HIGHWAY 441
Second Line	:	SUITE 6
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-6737
Country	:	US
Telephone Number	:	352-385-1944
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	CATHY P HALE
Credential	:
Telephone Number	:	352-385-1944

Provider Enumeration Date	:	05/07/2007
Last Update Date	:	08/22/2020

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Directions to “EUSTIS SPEECH AND LANGUAGE CENTER, INC ” Practice Location

Language	Start Address	Practice Location

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