Healthcare Provider Details

I. General information

NPI: 1225383490
Provider Name (Legal Business Name): BIANKA GISSEL LINARES M.S, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIANKA GISSEL VASQUEZZ M.S., CCC-SLP

II. Dates (important events)

Enumeration Date: 07/13/2012
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 E MICHIGAN AVE
LANSING MI
48912-1896
US

IV. Provider business mailing address

2615 OBAN RD
LANSING MI
48911-1343
US

V. Phone/Fax

Practice location:
  • Phone: 517-364-1000
  • Fax:
Mailing address:
  • Phone: 786-546-4836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ5834
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: