Healthcare Provider Details

I. General information

NPI: 1083881783
Provider Name (Legal Business Name): SPEECH & LANGUAGE PATHOLOGY OF C. FL., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2008
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 E HORATIO AVE STE 215
MAITLAND FL
32751-7314
US

IV. Provider business mailing address

PO BOX 291
WINTER PARK FL
32790-0291
US

V. Phone/Fax

Practice location:
  • Phone: 407-291-9393
  • Fax: 407-291-9699
Mailing address:
  • Phone: 407-291-9393
  • Fax: 407-291-9699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA1882
License Number StateFL

VIII. Authorized Official

Name: LAILA ESDEN
Title or Position: DIRECTOR/SP-LANGUAGE PATHOLOGIST
Credential: M.S./CCC-SLP
Phone: 407-291-9393