Healthcare Provider Details

I. General information

NPI: 1578099701
Provider Name (Legal Business Name): MS. KATHRYN ALEA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2017
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9167 SW 97TH AVE
MIAMI FL
33176-1939
US

IV. Provider business mailing address

9167 SW 97TH AVE
MIAMI FL
33176-1939
US

V. Phone/Fax

Practice location:
  • Phone: 786-423-9007
  • Fax:
Mailing address:
  • Phone: 786-423-9007
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License NumberSI2992
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ9198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: