=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225326374
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EXPRESS YOURSELF SPEECH LANGUAGE THERAPY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/11/2011
-----------------------------------------------------
Last Update Date | 12/07/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7040 SW 47TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-815-2693
-----------------------------------------------------
Fax | 305-328-4011
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7040 SW 47TH ST
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-4647
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-815-2693
-----------------------------------------------------
Fax | 305-328-4011
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. ANA MARIA RIVERO WEISS
-----------------------------------------------------
Credential | M.S., CCC-SLP
-----------------------------------------------------
Telephone | 305-815-2693
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | SA10005
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------