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General NPI Number Information
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NPI Number | 1548048796
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Entity Type | Organization
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Legal Business Name | SPEECH & DEVELOPMENT CLINIC, LLC.
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Dates
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Enumeration Date | 09/19/2023
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Last Update Date | 09/19/2023
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Provider Practice Location Address
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Address Line | BO. MALPASO CARR. 417 KM 2.3
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City | AGUADA
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State | PR
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Zip | 00602
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Country | US
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Telephone | 939-235-0543
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Fax |
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Provider Business Mailing Address
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Address Line | HC 60 BOX 15324
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City | AGUADA
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State | PR
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Zip | 00602-9273
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Country | US
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Telephone | 939-235-0543
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ISAMAR LORENZO LORENZO
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Credential | SLP
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Telephone | 939-235-0543
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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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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