Healthcare Provider Details

I. General information

NPI: 1700478690
Provider Name (Legal Business Name): INNOVATIVE NEUROLOGICAL SPEECH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 MAIN LN APT 1446
ORLANDO FL
32801-3888
US

IV. Provider business mailing address

820 MAIN LN APT 1446
ORLANDO FL
32801-3888
US

V. Phone/Fax

Practice location:
  • Phone: 513-240-8518
  • Fax:
Mailing address:
  • Phone: 513-240-8518
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MR. MIKEL M WILLIAMS
Title or Position: CEO/FOUNDER- SPEECH PATHOLOGIST
Credential: M.S., CCC-SLP
Phone: 513-240-8518