# INNOVATIVE SPEECH THERAPY GROUP

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1568792414
- **Authorized official:** JULIET WILLIAMS (PRESIDENT)
- **Authorized official phone:** (754) 234-6577

## Contact information

- **Practice address:** 1597 SW 194TH TER, PEMBROKE PINES, FL 33029-6161
- **Practice address phone:** (754) 234-6577
- **Mailing address:** 1597 SW 194TH TER, PEMBROKE PINES, FL 33029-6161
- **Mailing address phone:** (754) 234-6577

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 222Q00000X | Developmental Therapist | SA 9460 | FL | — |
| 235Z00000X | Speech-Language Pathologist | SA 9460 | FL | Yes |

## Other

- **Enumeration date:** 12/28/2009
- **Last updated:** 08/01/2012