Healthcare Provider Details

I. General information

NPI: 1346213576
Provider Name (Legal Business Name): SPECIALIZED SPEECH CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3335 N UNIVERSITY DR SUITE 5
HOLLYWOOD FL
33024-2200
US

IV. Provider business mailing address

3335 N UNIVERSITY DR SUITE 5
HOLLYWOOD FL
33024-2200
US

V. Phone/Fax

Practice location:
  • Phone: 954-442-9422
  • Fax: 954-442-9150
Mailing address:
  • Phone: 954-442-9422
  • Fax: 954-442-9150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License NumberOT11451
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA4906
License Number StateFL

VIII. Authorized Official

Name: JOHN TAMBASCO
Title or Position: VICE-PRESIDENT
Credential: MS/CCC-SLP
Phone: 954-442-9422