MEDICARE: SPEAK, MOVE, GROW, 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	261QH0700X	Hearing and Speech Clinic/Center	SA 9572	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

General Provider Information

NPI Number	:	1891161220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPEAK, MOVE, GROW, LLC

Provider Business Mailing Address
First Line	:	7765 SW 142ND ST
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33158-1514
Country	:	US
Telephone Number	:	305-323-2364
Fax Number	:

Provider Business Practice Location Address
First Line	:	7765 SW 142ND ST
Second Line	:
City	:	PALMETTO BAY
State	:	FL
Zip	:	33158-1514
Country	:	US
Telephone Number	:	305-323-2364
Fax Number	:

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	MRS. LORELLE B. VASCOS-PAGES
Credential	:	M.S., CCC-SLP
Telephone Number	:	305-323-2364

Provider Enumeration Date	:	08/20/2015
Last Update Date	:	08/20/2015

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Directions to “SPEAK, MOVE, GROW, LLC ” Practice Location

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