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General NPI Number Information
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NPI Number | 1316422215
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Entity Type | Organization
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Legal Business Name | BREAKTHROUGH BEHAVIOR, LLC
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Dates
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Enumeration Date | 09/27/2018
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Last Update Date | 09/20/2019
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Provider Practice Location Address
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Address Line | 8701 MAITLAND SUMMIT BLVD
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City | ORLANDO
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State | FL
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Zip | 32810-5915
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Country | US
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Telephone | 407-574-4629
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Fax | 407-965-4480
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Provider Business Mailing Address
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Address Line | 8701 MAITLAND SUMMIT BLVD
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City | ORLANDO
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State | FL
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Zip | 32810-5915
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Country | US
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Telephone | 407-574-4629
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Fax | 407-965-4480
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MAEGEN CHRISTINE PIERCE
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Credential |
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Telephone | 407-574-4629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number |
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License Number State |
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