| Entity Name: | SPEECH LANGUAGE PATHOLOGY CENTER OF MIAMI CORP |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Active |
| Date Filed: | 21 Feb 2014 (11 years ago) |
| Document Number: | P14000016460 |
| FEI/EIN Number | 46-4975469 |
| Address: | 15771 SW 141 COURT, MIAMI, FL, 33177 |
| Mail Address: | 15771 SW 141 COURT, MIAMI, FL, 33177 |
| ZIP code: | 33177 |
| County: | Miami-Dade |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1356769046 | 2014-03-31 | 2024-01-11 | 15771 SW 141ST CT, MIAMI, FL, 331776801, US | 15771 SW 141ST CT, MIAMI, FL, 331776801, US | |||||||||||||||||||||||
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| Phone | +1 786-553-9584 |
Authorized person
| Name | KRYSTEN NICHOLE GONZALEZ |
| Role | PRESIDENT |
| Phone | 7865539584 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA12523 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 006562400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| GONZALEZ KRYSTEN N | Agent | 15771 SW 141 COURT, MIAMI, FL, 33177 |
| Name | Role | Address |
|---|---|---|
| GONZALEZ KRYSTEN N | President | 15771 SW 141 COURT, MIAMI, FL, 33177 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-01-11 |
| ANNUAL REPORT | 2023-02-01 |
| ANNUAL REPORT | 2022-01-26 |
| ANNUAL REPORT | 2021-02-11 |
| ANNUAL REPORT | 2020-02-08 |
| ANNUAL REPORT | 2019-02-01 |
| ANNUAL REPORT | 2018-01-26 |
| ANNUAL REPORT | 2017-02-02 |
| ANNUAL REPORT | 2016-04-21 |
| ANNUAL REPORT | 2015-03-20 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
