Healthcare Provider Details

I. General information

NPI: 1144509100
Provider Name (Legal Business Name): DYNAMIC KIDS CONSULTING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2011
Last Update Date: 08/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 NW 2ND AVE
MIAMI FL
33127-4305
US

IV. Provider business mailing address

2501 NW 2ND AVE
MIAMI FL
33127-4305
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-7604
  • Fax: 305-576-7604
Mailing address:
  • Phone: 305-576-7604
  • Fax: 305-576-7604

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 Number
License Number State

VIII. Authorized Official

Name: MS. NINA M GINATTA
Title or Position: DIRECTOR
Credential: BCBA
Phone: 305-576-7604