| Entity Name: | ORLANDO SPEECH CLINIC LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Company |
| Status: | Active |
| Date Filed: | 02 May 2023 (2 years ago) |
| Document Number: | L23000216473 |
| FEI/EIN Number | 92-3812084 |
| Address: | 646 WEST SMITH STREET, UNIT 558, ORLANDO, FL 32804 |
| Mail Address: | 646 WEST SMITH STREET, UNIT 558, ORLANDO, FL 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1275222796 | 2023-05-01 | 2023-05-01 | 646 W SMITH ST UNIT 558, ORLANDO, FL, 328045384, US | 646 W SMITH ST UNIT 558, ORLANDO, FL, 328045384, US | |||||||||||||||||||
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| Phone | +1 407-883-3295 |
Authorized person
| Name | MS. IVANNA ORTIZ |
| Role | SPEECH LANGUAGE PATHOLOGIST/MANAGER |
| Phone | 4078833295 |
Taxonomy
| Taxonomy Code | 261QH0700X - Hearing and Speech Clinic/Center |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 1518352475 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| ORTIZ, IVANNA | Agent | 646 WEST SMITH STREET, UNIT 558, ORLANDO, FL 32804 |
| Name | Role | Address |
|---|---|---|
| ORTIZ, IVANNA | Authorized Member | 646 WEST SMITH STREET, UNIT 558, ORLANDO, FL 32804 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-04-28 |
| Florida Limited Liability | 2023-05-02 |
Date of last update: 10 Feb 2025
Sources: Florida Department of State
