Healthcare Provider Details

I. General information

NPI: 1528428869
Provider Name (Legal Business Name): SPEECH, LANGUAGE, AND BEHAVIOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 02/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 SPRING OAKS BLVD
ALTAMONTE SPRINGS FL
32714-7311
US

IV. Provider business mailing address

627 SPRING OAKS BLVD
ALTAMONTE SPRINGS FL
32714-7311
US

V. Phone/Fax

Practice location:
  • Phone: 407-280-3128
  • Fax:
Mailing address:
  • Phone: 407-280-3128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA7214
License Number StateFL

VIII. Authorized Official

Name: REBECCA WING KLEIMAN
Title or Position: OWNER
Credential: MS, CCC-SLP, BCBA
Phone: 407-280-3128