MEDICARE: CORRECTIVE SPEECH AND LANGUAGE THERAPY, INC.

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	251S00000X	Community/Behavioral Health Agency	SA6112	FL
2	252Y00000X	Early Intervention Provider Agency
3	103K00000X	Behavior Analyst
4	235Z00000X	Speech-Language Pathologist	SA6112	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356318489
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORRECTIVE SPEECH AND LANGUAGE THERAPY, INC.

Provider Business Mailing Address
First Line	:	14055 TOWN LOOP BLVD
Second Line	:	SUITE 300
City	:	ORLANDO
State	:	FL
Zip	:	32837-6105
Country	:	US
Telephone Number	:	407-857-6285
Fax Number	:	407-857-9566

Provider Business Practice Location Address
First Line	:	14055 TOWN LOOP BLVD
Second Line	:	SUITE 300
City	:	ORLANDO
State	:	FL
Zip	:	32837-6105
Country	:	US
Telephone Number	:	407-857-6285
Fax Number	:	407-857-9566

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MRS. RACHEL LEE SHOCKLEY
Credential	:	CCC-SLP
Telephone Number	:	407-857-6285

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	02/09/2022

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Directions to “CORRECTIVE SPEECH AND LANGUAGE THERAPY, INC. ” Practice Location

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