Provider Demographics
NPI:1104398056
Name:INFINITE SPEECH, SWALLOWING AND NEUROLOGICAL REHABILITATION LLC
Entity type:Organization
Organization Name:INFINITE SPEECH, SWALLOWING AND NEUROLOGICAL REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHANEL
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:MORRIS-STEPHENS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:707-140-6427
Mailing Address - Street 1:5635 GREEN ISLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7352
Mailing Address - Country:US
Mailing Address - Phone:770-714-0642
Mailing Address - Fax:
Practice Address - Street 1:5635 GREEN ISLAND BLVD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33463-7352
Practice Address - Country:US
Practice Address - Phone:770-714-0642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty