Healthcare Provider Details

I. General information

NPI: 1912408436
Provider Name (Legal Business Name): MIRBEN SPEECH LANGUAGE COMPANY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 04/17/2025
Certification Date: 04/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2309 WHISPERING MAPLE DR
ORLANDO FL
32837-6706
US

IV. Provider business mailing address

2309 WHISPERING MAPLE DR
ORLANDO FL
32837-6706
US

V. Phone/Fax

Practice location:
  • Phone: 689-204-9439
  • Fax: 914-455-0158
Mailing address:
  • Phone: 689-204-9439
  • Fax: 914-455-0158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: ESTHER M MIRANDA BENDEZU
Title or Position: OWNER AND MANAGING DIRECTOR
Credential: SLP
Phone: 689-204-9439