Healthcare Provider Details

I. General information

NPI: 1619079803
Provider Name (Legal Business Name): BARBARA LOREN ZUCKER M.A., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 COLLEGE AVE
DAVIE FL
33314-7721
US

IV. Provider business mailing address

PO BOX 290370
FT LAUDERDALE FL
33329-0370
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-7702
  • Fax: 954-262-2847
Mailing address:
  • Phone: 954-262-4346
  • Fax: 954-262-2269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA2917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: