Provider Demographics
NPI:1164010906
Name:COASTAL PEDIATRIC SPEECH THERAPY LLC
Entity type:Organization
Organization Name:COASTAL PEDIATRIC SPEECH THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:CINCA
Authorized Official - Suffix:
Authorized Official - Credentials:MA CCC/SLP
Authorized Official - Phone:321-537-1987
Mailing Address - Street 1:557 CAPRI RD
Mailing Address - Street 2:
Mailing Address - City:COCOA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32931-3011
Mailing Address - Country:US
Mailing Address - Phone:321-537-1987
Mailing Address - Fax:
Practice Address - Street 1:285 MCLEOD ST
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-3463
Practice Address - Country:US
Practice Address - Phone:321-537-1987
Practice Address - Fax:321-433-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-07
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty