Provider Demographics
NPI:1194095315
Name:SPEECH AND LANGUAGE ASSOCIATES
Entity type:Organization
Organization Name:SPEECH AND LANGUAGE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PATRICIA
Authorized Official - Last Name:STEPHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC/SLP
Authorized Official - Phone:352-373-5389
Mailing Address - Street 1:4631 NW 53RD AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32653-3402
Mailing Address - Country:US
Mailing Address - Phone:352-373-5389
Mailing Address - Fax:352-335-0517
Practice Address - Street 1:4631 NW 53RD AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32653-3402
Practice Address - Country:US
Practice Address - Phone:352-373-5389
Practice Address - Fax:352-335-0517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA112235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty