Provider Demographics
NPI:1124495791
Name:SUPER HERO SPEECH, P.A.
Entity type:Organization
Organization Name:SUPER HERO SPEECH, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ALEXIS
Authorized Official - Last Name:SAKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:786-306-2453
Mailing Address - Street 1:13155 SW 134TH ST STE 207
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4488
Mailing Address - Country:US
Mailing Address - Phone:786-306-2453
Mailing Address - Fax:305-506-6768
Practice Address - Street 1:13155 SW 134TH ST STE 207
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4488
Practice Address - Country:US
Practice Address - Phone:786-306-2453
Practice Address - Fax:305-506-6768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-29
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA13801235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019772100Medicaid