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General NPI Number Information
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NPI Number | 1609523372
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Entity Type | Organization
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Legal Business Name | MAVERICK SPEECH THERAPY LLC
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Dates
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Enumeration Date | 03/03/2022
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Last Update Date | 12/01/2022
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Provider Practice Location Address
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Address Line | 514 BAYFRONT DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-8644
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Country | US
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Telephone | 561-299-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 514 BAYFRONT DR
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-8644
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Country | US
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Telephone | 561-299-6333
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Fax |
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | CATHERINE ORDONEZ
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Credential | M.S., CCC-SLP
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Telephone | 561-299-6333
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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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