Provider Demographics
NPI:1962518092
Name:NOVEMBER & ASSOCIATES SPEECH-LANGUAGE & DEVELOPMENTAL CENTER, INC.
Entity type:Organization
Organization Name:NOVEMBER & ASSOCIATES SPEECH-LANGUAGE & DEVELOPMENTAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVEMBER
Authorized Official - Suffix:
Authorized Official - Credentials:MA, CCC-SLP
Authorized Official - Phone:772-342-1435
Mailing Address - Street 1:441 SE VERADA AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983-2242
Mailing Address - Country:US
Mailing Address - Phone:772-342-1435
Mailing Address - Fax:855-437-5783
Practice Address - Street 1:1948 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-5510
Practice Address - Country:US
Practice Address - Phone:772-342-1435
Practice Address - Fax:855-437-5783
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA618235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL890871100Medicaid