Provider Demographics
NPI:1104080704
Name:THE SPEECH LANGUAGE GROUP, LLC
Entity type:Organization
Organization Name:THE SPEECH LANGUAGE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:LAYLA
Authorized Official - Middle Name:LOVE
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC SLP
Authorized Official - Phone:850-685-0608
Mailing Address - Street 1:202 N WAUKESHA ST
Mailing Address - Street 2:
Mailing Address - City:BONIFAY
Mailing Address - State:FL
Mailing Address - Zip Code:32425-2244
Mailing Address - Country:US
Mailing Address - Phone:850-685-0608
Mailing Address - Fax:888-288-4965
Practice Address - Street 1:202 N WAUKESHA ST
Practice Address - Street 2:
Practice Address - City:BONIFAY
Practice Address - State:FL
Practice Address - Zip Code:32425-2244
Practice Address - Country:US
Practice Address - Phone:850-685-0608
Practice Address - Fax:888-288-4965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-12
Last Update Date:2008-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 8463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty