Provider Demographics
NPI:1487065488
Name:ADVANCE YOUR SPEECH, CORP.
Entity type:Organization
Organization Name:ADVANCE YOUR SPEECH, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LELLANY
Authorized Official - Middle Name:
Authorized Official - Last Name:VIVANCO
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:305-602-8098
Mailing Address - Street 1:1405 SW 107TH AVE STE 301-H1
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-2533
Mailing Address - Country:US
Mailing Address - Phone:305-602-8098
Mailing Address - Fax:305-602-8208
Practice Address - Street 1:1405 SW 107TH AVE STE 301-H1
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-2533
Practice Address - Country:US
Practice Address - Phone:305-602-8098
Practice Address - Fax:305-602-8208
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-13
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002781500Medicaid