Basic Information
| Provider Information | |||||||||
| NPI: | 1750648721 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WEE ACHIEVE THERAPY INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12910 98TH AVENUE N. | ||||||||
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| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7276436148 | ||||||||
| FaxNumber: | 7279543260 | ||||||||
| Practice Location | |||||||||
| Address1: | 12910 98TH AVENUE N. | ||||||||
| Address2: | |||||||||
| City: | SEMINOLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33776 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7276436148 | ||||||||
| FaxNumber: | 7279543260 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2012 | ||||||||
| LastUpdateDate: | 06/29/2022 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | KRISTIN | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | SPEECH LANGUAGE PATHOLOGIST/OWNER P | ||||||||
| AuthorizedOfficialTelephone: | 7276436148 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | M.S., CCC,SLP | ||||||||
| NPICertificationDate: | 06/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | SA5814 | Y | 193400000X SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 004850800 | 05 | FL | MEDICAID |