Healthcare Provider Details

I. General information

NPI: 1548974561
Provider Name (Legal Business Name): MY WORD SPEECH THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2023
Last Update Date: 07/05/2024
Certification Date: 07/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 VISCAYA PKWY STE 201
CAPE CORAL FL
33990-3294
US

IV. Provider business mailing address

222 NE 24TH AVE
CAPE CORAL FL
33909-2809
US

V. Phone/Fax

Practice location:
  • Phone: 239-286-4432
  • Fax: 866-759-5426
Mailing address:
  • Phone: 239-200-3721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: DR. LIZANDRA M GARCIA CARMONA
Title or Position: OWNER
Credential:
Phone: 239-200-3721