Basic Information
| Provider Information | |||||||||
| NPI: | 1083038301 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | LEVIEN | ||||||||
| FirstName: | ETHAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 W COLONIAL DR | ||||||||
| Address2: | STE. 300 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328047163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078523300 | ||||||||
| FaxNumber: | 4078523301 | ||||||||
| Practice Location | |||||||||
| Address1: | 5800 GOLF CLUB PKWY | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328084800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078523300 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2014 | ||||||||
| LastUpdateDate: | 02/06/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SZ6549 | FL | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.