MEDICARE: SPEECH AND LANGUAGE PEDIATRIC 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	261QH0700X	Hearing and Speech Clinic/Center	SZ6190	FL

General Provider Information

NPI Number	:	1851738249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEECH AND LANGUAGE PEDIATRIC THERAPY,INC

Provider Business Mailing Address
First Line	:	12001 SW 128TH CT STE 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4665
Country	:	US
Telephone Number	:	786-732-6983
Fax Number	:	786-732-6993

Provider Business Practice Location Address
First Line	:	12001 SW 128TH CT STE 101
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33186-4665
Country	:	US
Telephone Number	:	786-732-6983
Fax Number	:	786-732-6993

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOSE M HERNANDEZ
Credential	:	SPEECH LANGUAGE PATH
Telephone Number	:	786-732-6983

Provider Enumeration Date	:	05/27/2013
Last Update Date	:	05/27/2013

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

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