Provider Demographics
NPI:1366751885
Name:AIM 2 ACHIEVE SPEECH THERAPY & LEARNING CENTER
Entity type:Organization
Organization Name:AIM 2 ACHIEVE SPEECH THERAPY & LEARNING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:P
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-329-3442
Mailing Address - Street 1:622 DUNLIN LN
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34759-4534
Mailing Address - Country:US
Mailing Address - Phone:407-329-3442
Mailing Address - Fax:407-329-8170
Practice Address - Street 1:651 E MAIN ST STE 4
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-4241
Practice Address - Country:US
Practice Address - Phone:407-329-3442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA7486235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL118365400Medicaid
FL889413200Medicaid