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General NPI Number Information
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NPI Number | 1891161220
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Entity Type | Organization
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Legal Business Name | SPEAK, MOVE, GROW, LLC
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Dates
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Enumeration Date | 08/20/2015
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Last Update Date | 08/20/2015
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Provider Practice Location Address
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Address Line | 7765 SW 142ND ST
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City | PALMETTO BAY
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State | FL
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Zip | 33158-1514
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Country | US
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Telephone | 305-323-2364
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Fax |
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Provider Business Mailing Address
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Address Line | 7765 SW 142ND ST
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City | PALMETTO BAY
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State | FL
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Zip | 33158-1514
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Country | US
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Telephone | 305-323-2364
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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 | MRS. LORELLE B. VASCOS-PAGES
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Credential | M.S., CCC-SLP
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Telephone | 305-323-2364
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0700X
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Taxonomy Name | Hearing and Speech Clinic/Center
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License Number | SA 9572
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License Number State | FL
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