MEDICARE: MS. MARIE KATIANA ACLUCHE MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SA22523	FL

General Provider Information

NPI Number	:	1609803998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIE KATIANA ACLUCHE MS

Provider Business Mailing Address
First Line	:	1702 SW COMMARGO ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-2214
Country	:	US
Telephone Number	:	410-660-3697
Fax Number	:

Provider Business Practice Location Address
First Line	:	3300 FOREST HILL BLVD
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33406-5813
Country	:	US
Telephone Number	:	561-434-8000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	02/25/2025

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