Healthcare Provider Details

I. General information

NPI: 1477940831
Provider Name (Legal Business Name): SPEECH LANGUAGE COMMUNICATION SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2015
Last Update Date: 04/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

862 PARK LAKE CT
ORLANDO FL
32803-3908
US

IV. Provider business mailing address

862 PARK LAKE CT
ORLANDO FL
32803-3908
US

V. Phone/Fax

Practice location:
  • Phone: 407-717-6049
  • Fax:
Mailing address:
  • Phone: 407-717-6049
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: SAMANTHA HINSON
Title or Position: OWNER AND SPEECH-LANGUAGE PATHOLOGI
Credential: CCC-SLP
Phone: 407-717-6049