Healthcare Provider Details

I. General information

NPI: 1437744513
Provider Name (Legal Business Name): SUPERIOR SPEECH THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2021
Last Update Date: 01/02/2022
Certification Date: 01/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15614 MLK BLVD STE A
DOVER FL
33527-4213
US

IV. Provider business mailing address

5306 LENOIR CT
PLANT CITY FL
33566-8093
US

V. Phone/Fax

Practice location:
  • Phone: 813-719-0130
  • Fax:
Mailing address:
  • Phone: 813-719-0130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA P BREWER
Title or Position: SPEECH-LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 813-719-0130