Healthcare Provider Details

I. General information

NPI: 1578135232
Provider Name (Legal Business Name): FLORIDA SPEECH-LANGUAGE PATHOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11602 LAKE UNDERHILL RD STE 129
ORLANDO FL
32825-4460
US

IV. Provider business mailing address

4120 GABRIELLA LN
WINTER PARK FL
32792-6318
US

V. Phone/Fax

Practice location:
  • Phone: 407-340-4167
  • Fax:
Mailing address:
  • Phone: 407-340-4167
  • Fax: 407-327-7902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MELISSA DOAN
Title or Position: OWNER/SLP
Credential:
Phone: 407-340-4167