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General NPI Number Information
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NPI Number | 1639657216
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Entity Type | Organization
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Legal Business Name | SPEECH THERAPY INNOVATIONS
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Dates
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Enumeration Date | 08/05/2018
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Last Update Date | 08/05/2018
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Provider Practice Location Address
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Address Line | 279 MAGNOLIA PARK TRL
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City | SANFORD
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State | FL
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Zip | 32773-7215
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Country | US
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Telephone | 321-262-9463
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Fax |
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Provider Business Mailing Address
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Address Line | 279 MAGNOLIA PARK TRL
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City | SANFORD
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State | FL
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Zip | 32773-7215
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Country | US
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Telephone | 321-262-9463
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ANA M RIVERA RODRIGUEZ
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Credential | PHD CCC-SLP
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Telephone | 321-262-9463
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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 | SA10845
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License Number State | FL
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