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General NPI Number Information
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NPI Number | 1316644107
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Entity Type | Organization
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Legal Business Name | YELLOW BRICK ROAD THERAPY.
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Dates
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Enumeration Date | 02/13/2023
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Last Update Date | 04/22/2024
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Provider Practice Location Address
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Address Line | 12676 NW 9TH TER
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City | MIAMI
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State | FL
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Zip | 33182-2060
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Country | US
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Telephone | 786-747-1029
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Fax |
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Provider Business Mailing Address
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Address Line | 12676 NW 9TH TER
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City | MIAMI
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State | FL
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Zip | 33182-2060
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Country | US
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Telephone | 786-747-1029
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MILENA BASANEZ RAMIREZ
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Credential | MS. CCC-SLP
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Telephone | 786-747-1029
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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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Taxonomy #2
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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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