NPIMap

Organization Active NPI

Lactation, Early Intervention, and Feeding Therapies

  • Speech-Language Pathologist
  • Stuart, FL
National Provider Identifier
1497112171
Registry record updated Mar 15, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
SA 11146 Issued in FL
Legal business name
LACTATION, EARLY INTERVENTION, AND FEEDING THERAPIES
Practice address
615 SE Hibiscus Ave
Stuart, FL 34996-3602
Phone
(772) 485-4357
NPI assigned
Jan 26, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 15, 2017

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

Authorized official

Name
Amelia Fry, MS, CCC-SLP, IBCLCNPI 1275811242
Title
Speech Language Pathologist
Phone
(772) 485-4357

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Lactation Consultant (Non-RN)Group: 193200000X MULTI-SPECIALTY GROUP 174N00000X L-111185
Speech-Language PathologistGroup: 193200000X MULTI-SPECIALTY GROUP 235Z00000X SA 11146 FL Primary
Early Intervention Provider Agency 252Y00000X

Addresses

Primary practice location

615 SE Hibiscus Ave
Stuart, FL 34996-3602

Mailing address

615 SE Hibiscus Ave
Stuart, FL 34996-3602
Phone (772) 485-4357

Other identifiers 3

IdentifierTypeStateIssuer
L-111185OtherINTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS
004024000MedicaidFL
14030798OtherAMERICAN SPEECH AND HEARING ASSOCIATION

Other names 1

  • LEIF Therapies Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1453766400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489536000000",
    "number": "1497112171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "615 SE HIBISCUS AVE",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349963602",
            "telephone_number": "772-485-4357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 SE HIBISCUS AVE",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349963602",
            "telephone_number": "772-485-4357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LACTATION, EARLY INTERVENTION, AND FEEDING THERAPIES",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-26",
        "last_updated": "2017-03-15",
        "status": "A",
        "authorized_official_last_name": "FRY",
        "authorized_official_first_name": "AMELIA",
        "authorized_official_title_or_position": "SPEECH LANGUAGE PATHOLOGIST",
        "authorized_official_telephone_number": "772-485-4357",
        "authorized_official_credential": "MS, CCC-SLP, IBCLC"
    },
    "taxonomies": [
        {
            "code": "174N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Lactation Consultant, Non-RN",
            "state": null,
            "license": "L-111185",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA 11146",
            "primary": true
        },
        {
            "code": "252Y00000X",
            "taxonomy_group": "",
            "desc": "Early Intervention Provider Agency",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "INTERNATIONAL BOARD OF LACTATION CONSULTANT EXAMINERS",
            "identifier": "L-111185",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004024000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN SPEECH AND HEARING ASSOCIATION",
            "identifier": "14030798",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LEIF Therapies",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Stuart, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2017; 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.