Provider Demographics
NPI:1316644107
Name:YELLOW BRICK ROAD THERAPY.
Entity type:Organization
Organization Name:YELLOW BRICK ROAD THERAPY.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MILENA
Authorized Official - Middle Name:
Authorized Official - Last Name:BASANEZ RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:786-747-1029
Mailing Address - Street 1:12676 NW 9TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2060
Mailing Address - Country:US
Mailing Address - Phone:786-747-1029
Mailing Address - Fax:
Practice Address - Street 1:12676 NW 9TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33182-2060
Practice Address - Country:US
Practice Address - Phone:786-747-1029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-13
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty