Healthcare Provider Details

I. General information

NPI: 1942120340
Provider Name (Legal Business Name): GROVE SPEECH AND LANGUAGE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12430 SW 50TH ST APT 145
MIRAMAR FL
33027-5862
US

IV. Provider business mailing address

12430 SW 50TH ST APT 145
MIRAMAR FL
33027-5862
US

V. Phone/Fax

Practice location:
  • Phone: 781-521-8999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JEISEL TAVAREZ CABRERA
Title or Position: SPEECH LANGUAGE PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 786-309-8988