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General NPI Number Information
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NPI Number | 1598208407
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Entity Type | Organization
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Legal Business Name | SPEECH & RESOURCE GROUP, INC
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Dates
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Enumeration Date | 11/24/2016
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Last Update Date | 11/24/2016
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Provider Practice Location Address
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Address Line | 3300 NE 192ND ST 505
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City | AVENTURA
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State | FL
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Zip | 33180-2427
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Country | US
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Telephone | 518-779-9448
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 NE 192ND ST 505
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City | AVENTURA
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State | FL
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Zip | 33180-2427
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Country | US
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Telephone | 518-779-9448
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARIANA INES DE DONATIS
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Credential | SLP
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Telephone | 518-779-9448
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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 | SA10961
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License Number State | FL
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