Provider Demographics
NPI:1548048796
Name:SPEECH & DEVELOPMENT CLINIC, LLC.
Entity type:Organization
Organization Name:SPEECH & DEVELOPMENT CLINIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ISAMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:LORENZO LORENZO
Authorized Official - Suffix:
Authorized Official - Credentials:SLP
Authorized Official - Phone:939-235-0543
Mailing Address - Street 1:HC 60 BOX 15324
Mailing Address - Street 2:
Mailing Address - City:AGUADA
Mailing Address - State:PR
Mailing Address - Zip Code:00602-9273
Mailing Address - Country:US
Mailing Address - Phone:939-235-0543
Mailing Address - Fax:
Practice Address - Street 1:BO. MALPASO
Practice Address - Street 2:CARR. 417 KM 2.3
Practice Address - City:AGUADA
Practice Address - State:PR
Practice Address - Zip Code:00602
Practice Address - Country:US
Practice Address - Phone:939-235-0543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty