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General NPI Number Information
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NPI Number | 1487065488
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Entity Type | Organization
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Legal Business Name | ADVANCE YOUR SPEECH, CORP.
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Dates
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Enumeration Date | 05/13/2014
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Last Update Date | 07/11/2016
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Provider Practice Location Address
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Address Line | 1405 SW 107TH AVE STE 301-H1
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City | MIAMI
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State | FL
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Zip | 33174-2533
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Country | US
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Telephone | 305-602-8098
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Fax | 305-602-8208
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Provider Business Mailing Address
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Address Line | 1405 SW 107TH AVE STE 301-H1
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City | MIAMI
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State | FL
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Zip | 33174-2533
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Country | US
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Telephone | 305-602-8098
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Fax | 305-602-8208
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST / OWNER
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Name | LELLANY VIVANCO
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Credential | M.S. CCC-SLP
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Telephone | 305-602-8098
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225X00000X
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Taxonomy Name | Occupational Therapist
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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 | 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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