Provider Demographics
NPI:1851963904
Name:A PLUS SPEECH THERAPY PROFESSIONALS, INC.
Entity type:Organization
Organization Name:A PLUS SPEECH THERAPY PROFESSIONALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TISHUNDA
Authorized Official - Middle Name:JOHNSON
Authorized Official - Last Name:TULLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-464-3303
Mailing Address - Street 1:1801 S 23RD ST STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4830
Mailing Address - Country:US
Mailing Address - Phone:772-464-3303
Mailing Address - Fax:
Practice Address - Street 1:1801 S 23RD ST STE 2
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4830
Practice Address - Country:US
Practice Address - Phone:772-464-3303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013247600Medicaid