MEDICARE: IGMARIE MERCADO HERNANDEZ CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	10213	FL
2	235Z00000X	Speech-Language Pathologist	SA20776	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235885468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IGMARIE MERCADO HERNANDEZ CCC-SLP

Provider Business Mailing Address
First Line	:	3961 SW GREENWOOD WAY APT E
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-4646
Country	:	US
Telephone Number	:	787-515-0605
Fax Number	:

Provider Business Practice Location Address
First Line	:	3961 SW GREENWOOD WAY APT E
Second Line	:
City	:	PALM CITY
State	:	FL
Zip	:	34990-4646
Country	:	US
Telephone Number	:	787-515-0605
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/25/2022
Last Update Date	:	07/10/2023

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Directions to “ IGMARIE MERCADO HERNANDEZ CCC-SLP” Practice Location

Language	Start Address	Practice Location

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