Provider Demographics
NPI:1962077370
Name:TAKING FLIGHT PEDIATRIC SPEECH & LANGUAGE THERAPY, LLC
Entity type:Organization
Organization Name:TAKING FLIGHT PEDIATRIC SPEECH & LANGUAGE THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST/OWNER/EMPLOYEE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANA
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCCLURE
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:321-591-1250
Mailing Address - Street 1:4034 FENROSE CIR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-1213
Mailing Address - Country:US
Mailing Address - Phone:321-591-1250
Mailing Address - Fax:
Practice Address - Street 1:4034 FENROSE CIR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-1213
Practice Address - Country:US
Practice Address - Phone:321-591-1250
Practice Address - Fax:321-541-9147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-26
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty