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General NPI Number Information
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NPI Number | 1972744670
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Entity Type | Organization
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Legal Business Name | THE SPEECH PATHOLOGY GROUP, INC.
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 11/05/2009
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Provider Practice Location Address
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Address Line | 7581 SW 190TH ST
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City | CUTLER BAY
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State | FL
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Zip | 33157-7385
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Country | US
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Telephone | 786-246-0499
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Fax |
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Provider Business Mailing Address
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Address Line | 7581 SW 190TH ST
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City | CUTLER BAY
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State | FL
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Zip | 33157-7385
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Country | US
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Telephone | 786-246-0499
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Fax |
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Authorized Official
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Title or Position | SPEECH PATHOLOGIST/PRESIDENT
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Name | CRISTIN AGUILERA ABASCAL
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Credential | M.S., C.C.C, SLP
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Telephone | 786-246-0499
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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 | SA9119
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License Number State | FL
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