| Entity Name: | PEDIATRIC SPEECH AND LANGUAGE PATHOLOGIST, INC. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 10 Mar 1999 (26 years ago) |
| Document Number: | P99000023972 |
| FEI/EIN Number | 593566938 |
| Address: | 850 EDGEWATER DR, ORLANDO, FL, 32804 |
| Mail Address: | 850 EDGEWATER DR, ORLANDO, FL, 32804 |
| ZIP code: | 32804 |
| County: | Orange |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1386768208 | 2007-03-17 | 2020-08-22 | 850 EDGEWATER DR, ORLANDO, FL, 328046808, US | 850 EDGEWATER DR, ORLANDO, FL, 328046808, US | |||||||||||||||||||||||||
|
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| Phone | +1 407-318-7312 |
| Fax | 4074286154 |
Authorized person
| Name | MRS. MELANIE D. DOLL |
| Role | PRESIDENT |
| Phone | 4073187312 |
Taxonomy
| Taxonomy Code | 235Z00000X - Speech-Language Pathologist |
| License Number | SA 3688 |
| State | FL |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 8830509 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| CHALIFOUX DEBBIE R | Agent | 6105 LAKE LIZZIE DR, SAINT CLOUD, FL, 34771 |
| Name | Role | Address |
|---|---|---|
| DOLL MELANIE D | President | 850 EDGEWATER DR., ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| DOLL MELANIE D | Treasurer | 850 EDGEWATER DR., ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| DOLL MELANIE D | Director | 850 EDGEWATER DR., ORLANDO, FL, 32804 |
| DOLL PHILIP F | Director | 850 EDGEWATER DR., ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| DOLL PHILIP F | Vice President | 850 EDGEWATER DR., ORLANDO, FL, 32804 |
| Name | Role | Address |
|---|---|---|
| DOLL PHILIP F | Secretary | 850 EDGEWATER DR., ORLANDO, FL, 32804 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2014-09-26 | No data | No data |
| CANCEL ADM DISS/REV | 2007-05-09 | No data | No data |
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2006-09-15 | No data | No data |
Date of last update: 01 Jan 2025
Sources: Florida Department of State
