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General NPI Number Information
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NPI Number | 1699032698
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Entity Type | Organization
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Legal Business Name | CREA SPEECH AND LANGUAGE THERAPY, LLC
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Dates
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Enumeration Date | 04/13/2012
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Last Update Date | 04/13/2012
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Provider Practice Location Address
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Address Line | 2368 SW 26TH ST
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City | MIAMI
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State | FL
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Zip | 33133-2306
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Country | US
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Telephone | 786-344-8175
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Fax | 305-857-9788
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Provider Business Mailing Address
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Address Line | 2368 SW 26TH ST
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City | MIAMI
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State | FL
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Zip | 33133-2306
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Country | US
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Telephone | 786-344-8175
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Fax | 305-857-9788
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Authorized Official
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Title or Position | SPEECH AND LANGUAGE PATHOLOGIST
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Name | MARTINICA BARRIONUEVO
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Credential |
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Telephone | 786-344-8175
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SA 10156
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License Number State | FL
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