Provider Demographics
NPI:1154946366
Name:FOURTH ENHANCED SPEECH THERAPY SERVICES, LLC
Entity type:Organization
Organization Name:FOURTH ENHANCED SPEECH THERAPY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:FOURTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-435-0191
Mailing Address - Street 1:3020 MESA VERDE DR APT 1906
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4369
Mailing Address - Country:US
Mailing Address - Phone:407-435-0191
Mailing Address - Fax:
Practice Address - Street 1:3020 MESA VERDE DR APT 1906
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-4369
Practice Address - Country:US
Practice Address - Phone:407-435-0191
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty