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General NPI Number Information
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NPI Number | 1194369637
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Entity Type | Organization
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Legal Business Name | SPEECH THERAPY IN EARLY AGE, INC
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Dates
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Enumeration Date | 10/28/2019
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Last Update Date | 10/28/2019
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Provider Practice Location Address
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Address Line | 1611 NW 89TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-4753
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Country | US
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Telephone | 305-498-4097
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Fax |
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Provider Business Mailing Address
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Address Line | 1611 NW 89TH AVE
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City | PEMBROKE PINES
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State | FL
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Zip | 33024-4753
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Country | US
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Telephone | 305-498-4097
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | YARELIS CHIONG LOBAINA
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Credential | SLP
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Telephone | 305-498-4097
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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