Sagamore School, LLC

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SA5302 Issued in FL

Legal business name

SAGAMORE SCHOOL, LLC

Practice address

6820 Lyons Technology Pkwy
Suite 230
Coconut Creek, FL 33073-4314

Phone

(954) 420-9566

Fax

(954) 905-4382

NPI assigned

Apr 9, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Lisa Rachel Grossman, E.D.D., CCC-SLP

Title

Co-Owner

Phone

(954) 420-9566

Specialties & licenses 6

Addresses

Locations

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

{
    "created_epoch": "1365465600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365465600000",
    "number": "1588007652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6820 LYONS TECHNOLOGY CIRCLE",
            "address_2": "SUITE 230",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "33073",
            "telephone_number": "954-420-9566",
            "fax_number": "954-905-4382"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6820 LYONS TECHNOLOGY PKWY",
            "address_2": "SUITE 230",
            "city": "COCONUT CREEK",
            "state": "FL",
            "postal_code": "330734314",
            "telephone_number": "954-420-9566",
            "fax_number": "954-905-4382"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAGAMORE SCHOOL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-09",
        "last_updated": "2013-04-09",
        "status": "A",
        "authorized_official_last_name": "GROSSMAN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "RACHEL",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "954-420-9566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "E.D.D., CCC-SLP"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "SW9748",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "FL",
            "license": "MT1955",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA5302",
            "primary": true
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA7678",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA4869",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Speech-Language Pathologist",
            "state": "FL",
            "license": "SA10302",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Coconut Creek, FL
• Providers in Coconut Creek, FL by specialty
• Speech-Language Pathologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2013; 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.