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Organization
SPEECH LANGUAGE PATHOLOGY CENTER OF MIAMI CORP
Active
Organization
SPEECH LANGUAGE PATHOLOGY CENTER OF MIAMI CORP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTEN NICHOLE GONZALEZ M.S. CCC-SLP (PRESIDENT)
(786) 553-9584
Entity
Organization
Contact information
Practice address
15771 SW 141ST CT, MIAMI, FL 33177-6801
(786) 553-9584
Mailing address
15771 SW 141ST CT, MIAMI, FL 33177-6801
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SA12523
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006562400
—
FL
Enumeration date
03/31/2014
Last updated
01/11/2024
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