Provider Demographics
NPI:1124344528
Name:SPEECH AND LEARNING INSTITUTE, INC.
Entity type:Organization
Organization Name:SPEECH AND LEARNING INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:THEECK
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC-SLP
Authorized Official - Phone:561-776-8612
Mailing Address - Street 1:301 SUN TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33403-1188
Mailing Address - Country:US
Mailing Address - Phone:561-776-8612
Mailing Address - Fax:561-623-7515
Practice Address - Street 1:1201 US HIGHWAY 1 STE 215
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-3547
Practice Address - Country:US
Practice Address - Phone:561-776-8612
Practice Address - Fax:561-623-7515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7555261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL8895171-00Medicaid