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General NPI Number Information
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NPI Number | 1396969705
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Entity Type | Organization
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Legal Business Name | FLORIDA SPEECH & LANGUAGE LLC
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Dates
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Enumeration Date | 04/13/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4108 LAKE UNDERHILL RD SUITE 304
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City | ORLANDO
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State | FL
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Zip | 32803-7080
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Country | US
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Telephone | 407-625-9031
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Fax | 407-896-0214
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Provider Business Mailing Address
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Address Line | 4108 LAKE UNDERHILL RD SUITE 304
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City | ORLANDO
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State | FL
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Zip | 32803-7080
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Country | US
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Telephone | 407-625-9031
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Fax | 407-896-0214
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | MALLORI JO ROSSING
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Credential | M.A. CCC-SLP
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Telephone | 407-625-9031
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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 | SA 6942
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License Number State | FL
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