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Organization
WEST ORANGE SPEECH PATHOLOGIST, INC.
Active
Organization
WEST ORANGE SPEECH PATHOLOGIST, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LINDA TATUM-RILEY M.S. CCC-SLP (CEO/SLP)
(407) 298-5300
Entity
Organization
Contact information
Practice address
6388 SILVER STAR RD STE 2E, ORLANDO, FL 32818-3235
(407) 298-5300
(407) 296-0026
Mailing address
PO BOX 555907, ORLANDO, FL 32855-5907
(407) 298-5300
(407) 296-0026
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA1245
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18348
STAYWELL / WELLCARE
FL
01
—
202579
AMERIGROUP
FL
01
—
880650196
MEDWAIVER
FL
05
—
882834200
—
FL
Enumeration date
04/24/2008
Last updated
04/24/2008
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