Provider Demographics
NPI:1487806428
Name:CHILDREN'S COMMUNICATION CENTER, INC.
Entity type:Organization
Organization Name:CHILDREN'S COMMUNICATION CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:SAVAGE
Authorized Official - Last Name:GRAYSON
Authorized Official - Suffix:
Authorized Official - Credentials:MMSC, CCC-SLP
Authorized Official - Phone:850-386-8886
Mailing Address - Street 1:PO BOX 15545
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32317-5545
Mailing Address - Country:US
Mailing Address - Phone:850-386-8886
Mailing Address - Fax:850-385-6465
Practice Address - Street 1:2510 ARMISTEAD RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-0908
Practice Address - Country:US
Practice Address - Phone:850-386-8886
Practice Address - Fax:850-385-6465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1485235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FM883807100Medicaid