Provider Demographics
NPI:1114726445
Name:KOALATY SPEECH AND FEEDING THERAPY SERVICES LLC
Entity type:Organization
Organization Name:KOALATY SPEECH AND FEEDING THERAPY SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BOBO
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:863-944-8940
Mailing Address - Street 1:6944 KRENSON OAKS ST
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-2160
Mailing Address - Country:US
Mailing Address - Phone:863-944-8940
Mailing Address - Fax:
Practice Address - Street 1:6944 KRENSON OAKS ST
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-2160
Practice Address - Country:US
Practice Address - Phone:863-944-8940
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-10
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech