Speech Language Pathology Center of Miami Corp

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA12523 Issued in FL

Legal business name

SPEECH LANGUAGE PATHOLOGY CENTER OF MIAMI CORP

Practice address

15771 SW 141St CT
Miami, FL 33177-6801

Phone

(786) 553-9584

NPI assigned

Mar 31, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Krysten Nichole Gonzalez, M.S. CCC-SLP

Title

President

Phone

(786) 553-9584

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1396224000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704931200000",
    "number": "1356769046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15771 SW 141ST CT",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331776801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15771 SW 141ST CT",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331776801",
            "telephone_number": "786-553-9584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEECH LANGUAGE PATHOLOGY CENTER OF MIAMI CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-31",
        "last_updated": "2024-01-11",
        "certification_date": "2024-01-11",
        "status": "A",
        "authorized_official_last_name": "GONZALEZ",
        "authorized_official_first_name": "KRYSTEN",
        "authorized_official_middle_name": "NICHOLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "786-553-9584",
        "authorized_official_credential": "M.S. CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA12523",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006562400",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.