=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013155118
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CAN DO KIDS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2009
-----------------------------------------------------
Last Update Date | 01/27/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1273 KASS CIR
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-4308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-808-8986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1273 KASS CIR
-----------------------------------------------------
City | SPRING HILL
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34606-4308
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-808-8986
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MRS. LESLIE M GOOCH
-----------------------------------------------------
Credential | M.S.CCC/SLP
-----------------------------------------------------
Telephone | 727-808-8986
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA4615
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------