Provider Demographics
NPI:1871928523
Name:MARCIMOUTH SPEECH AND LANGUAGE SERVICES, INC.
Entity type:Organization
Organization Name:MARCIMOUTH SPEECH AND LANGUAGE SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAVES
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP
Authorized Official - Phone:561-790-1864
Mailing Address - Street 1:12777 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 1503
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4775
Mailing Address - Country:US
Mailing Address - Phone:561-790-1864
Mailing Address - Fax:561-429-3081
Practice Address - Street 1:12777 FOREST HILL BLVD
Practice Address - Street 2:SUITE 1503
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-4775
Practice Address - Country:US
Practice Address - Phone:561-790-1864
Practice Address - Fax:561-429-3081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-12
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7781235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891104500Medicaid