Provider Demographics
NPI:1568497527
Name:THE UNIVERSITY OF CENTRAL FLORIDA BOARD OF TRUSTEES
Entity type:Organization
Organization Name:THE UNIVERSITY OF CENTRAL FLORIDA BOARD OF TRUSTEES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:GAIL
Authorized Official - Last Name:KNOX
Authorized Official - Suffix:
Authorized Official - Credentials:MS CCC-SLP
Authorized Official - Phone:407-882-0468
Mailing Address - Street 1:3280 PROGRESS DR STE 500
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-2903
Mailing Address - Country:US
Mailing Address - Phone:407-882-0468
Mailing Address - Fax:407-904-8120
Practice Address - Street 1:3280 PROGRESS DR STE 500
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-2903
Practice Address - Country:US
Practice Address - Phone:407-882-0468
Practice Address - Fax:407-904-8120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2023-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA1747235Z00000X
FLSA2208235Z00000X
FLSA1762235Z00000X
FLSA1559235Z00000X
FLSA9235Z00000X
FLSA3799235Z00000X
FLSA6501235Z00000X
FLSA7017235Z00000X
FLSA5701235Z00000X
FLSA5847235Z00000X
FLSA5133235Z00000X
235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty