Provider Demographics
NPI:1902986029
Name:LYDIA REID M.A. CCC-SLP.D, P.A.
Entity Type:Organization
Organization Name:LYDIA REID M.A. CCC-SLP.D, P.A.
Other - Org Name:PERFECT SPEECH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SPEECH LANGUAGE PATHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:DACHELL
Authorized Official - Last Name:REID
Authorized Official - Suffix:
Authorized Official - Credentials:SLPD
Authorized Official - Phone:954-775-5013
Mailing Address - Street 1:5720 SW 195TH TER
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST RANCHES
Mailing Address - State:FL
Mailing Address - Zip Code:33332-1204
Mailing Address - Country:US
Mailing Address - Phone:954-775-5013
Mailing Address - Fax:
Practice Address - Street 1:45 NW 8TH ST STE 103
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4452
Practice Address - Country:US
Practice Address - Phone:305-248-5446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA 4876235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL891531800Medicaid