Basic Information
| Provider Information | |||||||||
| NPI: | 1336171826 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL FLORIDA SPEECH & HEARING CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3020 LAKELAND HIGHLANDS ROAD | ||||||||
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| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338034338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636863189 | ||||||||
| FaxNumber: | 8636821348 | ||||||||
| Practice Location | |||||||||
| Address1: | 3020 LAKELAND HIGHLANDS ROAD | ||||||||
| Address2: | |||||||||
| City: | LAKELAND | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338034338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8636863189 | ||||||||
| FaxNumber: | 8636821348 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2006 | ||||||||
| LastUpdateDate: | 07/28/2021 | ||||||||
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| AuthorizedOfficialLastName: | HOLLAND | ||||||||
| AuthorizedOfficialFirstName: | SUZANNE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS ACCOUNTS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8636863189 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 07/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 231H00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Audiologist | 2355A2700X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Specialist/Technologist | Audiology Assistant | 235Z00000X | FL | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 235Z00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 085626601 | 05 | FL | MEDICAID | 672202496 | 01 | FL | MEDWAIVER | OTHER | 244 | 01 | FL | ATA | OTHER | 085626600 | 05 | FL | MEDICAID | 206030 | 01 | FL | AMERIGROUP | OTHER | J0153 | 01 | FL | BLUE CROSS BLUE SHIELD | OTHER | 10628201 | 01 | FL | CITNUS CARE | OTHER |