Organization
RIVERSIDE SPEECH & LANGUAGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMY ROYALL MSCCCSLP (OWNER)
(941) 807-2863
Entity
Organization
Contact information
Practice address
2620 MANATEE AVE W, SUITE C, BRADENTON, FL 34205-4944
(941) 807-2863
Mailing address
808 HILLCREST DR, BRADENTON, FL 34209-1846
Taxonomy
Speciality
Code
Description
License number
State
222Q00000X
Developmental Therapist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
FL
Enumeration date
07/16/2010
Last updated
07/16/2010
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