| Entity Name: | CREA SPEECH AND LANGUAGE THERAPY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 06 Apr 2011 (14 years ago) |
| Last Event: | REINSTATEMENT |
| Event Date Filed: | 02 Oct 2017 (7 years ago) |
| Document Number: | L11000041027 |
| FEI/EIN Number | 451718353 |
| Address: | 3291 SW 26TH STREET, #1, MIAMI, FL, 33133, US |
| Mail Address: | 3291 SW 26TH STREET, unit 1, MIAMI, FL, 33133, US |
| ZIP code: | 33133 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699032698 | 2012-04-13 | 2012-04-13 | 2368 SW 26TH ST, MIAMI, FL, 331332306, US | 2368 SW 26TH ST, MIAMI, FL, 331332306, US | |||||||||||||||||||||||||
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| Phone | +1 786-344-8175 |
| Fax | 3058579788 |
Authorized person
| Name | MARTINICA BARRIONUEVO |
| Role | SPEECH AND LANGUAGE PATHOLOGIST |
| Phone | 7863448175 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA 10156 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 000631000 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| BARRIONUEVO MARTINICA | Agent | 3291 SW 26TH STREET, MIAMI, FL, 33133 |
| Name | Role | Address |
|---|---|---|
| BARRIONUEVO MARTINICA | Manager | 3291` SW 26TH STREET, MIAMI, FL, 33133 |
| Name | Role | Address |
|---|---|---|
| Dulce Raul | Auth | 3291 SW 26TH STREET, MIAMI, FL, 33133 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| REGISTERED AGENT ADDRESS CHANGED | 2017-10-02 | 3291 SW 26TH STREET, unit 1, MIAMI, FL 33133 | No data |
| REINSTATEMENT | 2017-10-02 | No data | No data |
| CHANGE OF MAILING ADDRESS | 2017-10-02 | 3291 SW 26TH STREET, #1, MIAMI, FL 33133 | No data |
| REGISTERED AGENT NAME CHANGED | 2017-10-02 | BARRIONUEVO, MARTINICA | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2017-09-22 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2016-04-25 | 3291 SW 26TH STREET, #1, MIAMI, FL 33133 | No data |
| LC STMNT OF RA/RO CHG | 2015-09-16 | No data | No data |
| REINSTATEMENT | 2013-10-07 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2013-09-27 | No data | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-28 |
| ANNUAL REPORT | 2023-02-08 |
| ANNUAL REPORT | 2022-03-14 |
| ANNUAL REPORT | 2021-04-09 |
| ANNUAL REPORT | 2020-04-28 |
| ANNUAL REPORT | 2019-04-04 |
| ANNUAL REPORT | 2018-03-02 |
| REINSTATEMENT | 2017-10-02 |
| ANNUAL REPORT | 2016-04-25 |
| CORLCRACHG | 2015-09-16 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
