Healthcare Provider Details

I. General information

NPI: 1205239621
Provider Name (Legal Business Name): DEANNA TORRES MCD, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 09/14/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

657 CENOTE CIR APT. 12301
ST. AUGUSTINE FL
32092
US

IV. Provider business mailing address

657 CENOTE CIR APT. 12301
ST. AUGUSTINE FL
32092
US

V. Phone/Fax

Practice location:
  • Phone: 843-206-4098
  • Fax:
Mailing address:
  • Phone: 843-206-4098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA14717
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: