MEDICARE: INTEGRATED SPEECH THERAPY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA5309	FL

General Provider Information

NPI Number	:	1104163963
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATED SPEECH THERAPY LLC

Provider Business Mailing Address
First Line	:	10105 AVENIDA DEL RIO
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2423
Country	:	US
Telephone Number	:	561-702-3965
Fax Number	:	561-638-5880

Provider Business Practice Location Address
First Line	:	10105 AVENIDA DEL RIO
Second Line	:
City	:	DELRAY BEACH
State	:	FL
Zip	:	33446-2423
Country	:	US
Telephone Number	:	561-702-3965
Fax Number	:	561-638-5880

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ANDREA GOTTLIEB
Credential	:	MS CCC/SLP
Telephone Number	:	561-702-3965

Provider Enumeration Date	:	01/12/2013
Last Update Date	:	01/12/2013

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Directions to “INTEGRATED SPEECH THERAPY LLC ” Practice Location

Language	Start Address	Practice Location

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