Healthcare Provider Details

I. General information

NPI: 1356743686
Provider Name (Legal Business Name): KENDALL SPEECH AND LANGUAGE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10743 SW 104 STREET
MIAMI FL
33176
US

IV. Provider business mailing address

10743 SW 104 STREET
MIAMI FL
33176
US

V. Phone/Fax

Practice location:
  • Phone: 305-274-7883
  • Fax: 305-274-4271
Mailing address:
  • Phone: 305-274-7883
  • Fax: 305-274-4271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ6838
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE VARTZBEDIAN GARABEDIAN
Title or Position: OFFICE MANAGER
Credential:
Phone: 305-274-7883