Provider Demographics
NPI:1285795807
Name:KIDSPEAK
Entity type:Organization
Organization Name:KIDSPEAK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARROLL
Authorized Official - Middle Name:FRANICINA
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:954-793-0148
Mailing Address - Street 1:2740 NW 17TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-4402
Mailing Address - Country:US
Mailing Address - Phone:954-793-0148
Mailing Address - Fax:954-301-0645
Practice Address - Street 1:2740 NW 17TH ST
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-4402
Practice Address - Country:US
Practice Address - Phone:954-793-0148
Practice Address - Fax:954-301-0645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 7325235Z00000X
FLSA5918235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty