| Entity Name: | MIJARES SPEECH LANGUAGE PATHOLOGY, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 27 Sep 2021 (3 years ago) |
| Document Number: | L21000423144 |
| FEI/EIN Number | 872859125 |
| Address: | 3042 CARLOW CIRCLE, TALLAHASSEE, FL, 32309, US |
| Mail Address: | 3042 CARLOW CIRCLE, TALLAHASSEE, FL, 32309, US |
| ZIP code: | 32309 |
| County: | Leon |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1992466098 | 2022-01-01 | 2022-01-01 | 3042 CARLOW CIR, TALLAHASSEE, FL, 323093303, US | 3042 CARLOW CIR, TALLAHASSEE, FL, 323093303, US | |||||||||||||||||||||||
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| Phone | +1 850-296-7107 |
| Fax | 8508075114 |
| Phone | +1 850-296-7106 |
Authorized person
| Name | EILEEN S MIJARES |
| Role | OWNER |
| Phone | 8502967106 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1962548487 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| MIJARES EILEEN S | Agent | 3042 CARLOW CIRCLE, TALLAHASSEE, FL, 32309 |
| Name | Role | Address |
|---|---|---|
| MIJARES EILEEN S | Manager | 3042 CARLOW CIRCLE, TALLAHASSEE, FL, 32309 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-06 |
| ANNUAL REPORT | 2023-01-30 |
| ANNUAL REPORT | 2022-02-22 |
| Florida Limited Liability | 2021-09-27 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
