Provider Demographics
NPI:1215288667
Name:SPEECH AND OCCUPATIONAL SPECIALISTS, LLC
Entity type:Organization
Organization Name:SPEECH AND OCCUPATIONAL SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLESEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-399-6556
Mailing Address - Street 1:12536 WESTFIELD LAKES CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-5275
Mailing Address - Country:US
Mailing Address - Phone:407-399-6556
Mailing Address - Fax:
Practice Address - Street 1:1201 WINTER GARDEN VINELAND RD STE 10
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-4380
Practice Address - Country:US
Practice Address - Phone:407-654-5455
Practice Address - Fax:407-654-5829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-25
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL225X00000X
FLSA9546235Z00000X
261Q00000X, 261QR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007154402Medicaid
FLHG468AOtherMEDICARE
FL007154400Medicaid
FL007154401Medicaid